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J Knee Surg 2021; 34(14): 1587-1591
DOI: 10.1055/s-0040-1710563
Original Article

Acute Total Knee Replacement in Rheumatoid Arthritis Patients with Proximal Tibial Fractures: A Case Series

Fardin Mirzatolooei
1   Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
,
Ali Tabrizi 
1   Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
,
Mir Bahram Safari
1   Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
,
Seyed Amir Mahlisha Kazemi Shishavan
2   Department of Orthopedics, Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran
› Author Affiliations Funding This study was financially supported by Urmia University of Medical sciences.
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Abstract

Management of proximal tibial fractures is a challenging issue in patients with rheumatoid arthritis (RA). In the present study, we aimed to describe our experience of acute total knee replacement in RA patients. This case series included 11 RA patients with simultaneous insufficiency fractures of the proximal tibia, who were treated by acute total knee replacement. Midterm functional results, severity of pain, Hospital for Special Surgery (HSS), and Knee Society Score (KSS) parameters were evaluated in this study. The patients were followed up for 24 months. Eleven women with proximal tibial fractures and history of RA (mean age: 54.3 ± 4.7 years) were enrolled in this study. The mean score of Tegner activity scale was 2.2 ± 1.4 preoperatively, which significantly improved to 4.3 ± 1.4 postoperatively (p < 0.001). The two sections of KSS (knee and function section) averaged 88.7 ± 5.4 and 59.4 ± 8.2, respectively. There wasn't poor outcome and excellent result was in knee section 54.5% and function section 36.3% based on KSS. The mean score of pain severity during normal activity before fracture was 65.2 ± 12.3, which significantly reduced to 35.5 ± 11.3 in the final follow-up (p = 0.02). The score of HSS scale improved from 42 (range: 16–58) in the preoperative stage to 78 (range: 72–91) after surgery (p < 0.001). In the 6-month follow-up, deep vein thrombosis was reported in two patients. The time required to return to normal activity was 5.5 ± 2.3 months. Based on the findings, total knee replacement therapy in patients with RA and proximal tibial fractures produced excellent clinical outcomes, which led to rapid return to normal activity. This is a Level IV, therapeutic study.

Keywords

rheumatoid arthritis - osteoporosis - proximal tibial fractures - total knee replacement

Ethical Approval

This study was approved by the Ethics Committee of Urmia University of Medical Sciences.




Publication History

Received: 21 December 2018

Accepted: 31 March 2020

Article published online:
25 May 2020

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  • References

  • 1 Liao CY, Chan HT, Chao E, Yang CM, Lu TC. Comparison of total hip and knee joint replacement in patients with rheumatoid arthritis and osteoarthritis: a nationwide, population-based study. Singapore Med J 2015; 56 (01) 58-64
    CrossrefPubMedGoogle Scholar
  • 2 Ravi B, Croxford R, Hollands S. et al. Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis. Arthritis Rheumatol 2014; 66 (02) 254-263
    Google Scholar
  • 3 Hooghof JT, Mellema JJ, Posthumus MD, van Raaij JJ. A woman with rheumatoid arthritis and a bilateral fracture of the proximal tibia. Case Rep Orthop 2016; 2016: 5094906
    PubMedGoogle Scholar
  • 4 Erdogan F, Sarikaya IA, Can A, Gorgun B. Management of knee rheumatoid arthritis and tibia nonunion with one-stage total knee arthroplasty and intramedullary nailing: a report of two cases. Acta Orthop Traumatol Turc 2018; 52 (01) 65-69
    CrossrefPubMedGoogle Scholar
  • 5 Sarzaeem MM, Omidian MM, Kazemian G, Manafi A. Acute primary total knee arthroplasty for proximal tibial fractures in elderly. Arch Bone Jt Surg 2017; 5 (05) 302-307
    PubMedGoogle Scholar
  • 6 Chmell MJ, Scott RD. Total knee arthroplasty in patients with rheumatoid arthritis. An overview. Clin Orthop Relat Res 1999; (366) 54-60
    CrossrefPubMedGoogle Scholar
  • 7 Kirwan JR. The Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med 1995; 333 (03) 142-146
    CrossrefPubMedGoogle Scholar
  • 8 Narin S, Unver B, Bakırhan S, Bozan O, Karatosun V. Cross-cultural adaptation, reliability and validity of the Turkish version of the Hospital for Special Surgery (HSS) Knee Score. Acta Orthop Traumatol Turc 2014; 48 (03) 241-248
    CrossrefPubMedGoogle Scholar
  • 9 Tey IK, Chong K, Singh I. Stress fracture of the distal tibia secondary to severe knee osteoarthritis: a case report. J Orthop Surg (Hong Kong) 2006; 14 (02) 212-215
    CrossrefPubMedGoogle Scholar
  • 10 Haspl M, Jelić M, Pećina M. Arthroplasty in treating knee osteoarthritis and proximal tibia stress fracture. Acta Chir Orthop Traumatol Cech 2003; 70 (05) 303-305
    PubMedGoogle Scholar
  • 11 Tomlinson MP, Dingwall IM, Phillips H. Total knee arthroplasty in the management of proximal tibial stress fractures. J Arthroplasty 1995; 10 (05) 707-713
    CrossrefPubMedGoogle Scholar
  • 12 Softness KA, Murray RS, Evans BG. Total knee arthroplasty and fractures of the tibial plateau. World J Orthop 2017; 8 (02) 107-114
    CrossrefPubMedGoogle Scholar
  • 13 Eid AS, Nassar WA, Fayyad TA. Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee. Int Orthop 2016; 40 (11) 2289-2293
    CrossrefPubMedGoogle Scholar