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Posterior Cruciate Ligament-Retaining Total Knee Arthroplasty in Patients with Rheumatoid Arthritis

Archibeck, Michael J. MD; Berger, Richard A. MD; Barden, Regina M. RN; Jacobs, Joshua J. MD; Sheinkop, Mitchell B. MD; Rosenberg, Aaron G. MD; Galante, Jorge O. MD

Journal of Bone & Joint Surgery - American Volume: August 2001 - Volume 83 - Issue 8 - p 1231–1236
Article

Background: Although initial reports on posterior cruciate ligament-retaining total knee arthroplasty in patients with rheumatoid arthritis have been encouraging, a high rate of late instability necessitating revision has been reported recently. The purpose of the present prospective study was to analyze the results of posterior cruciate ligament-retaining total knee arthroplasty in patients with rheumatoid arthritis.

Methods: Seventy‐two posterior cruciate ligament-retaining total knee arthroplasties in fifty‐one patients with rheumatoid arthritis were studied prospectively. All procedures were performed with the Miller-Galante I prosthesis. Eighteen patients (twenty-four knees) died before the eight-year follow‐up and one patient (two knees) was lost to follow-up, leaving forty-six knees (thirty-two patients) for review. These forty-six knees were evaluated clinically (with particular attention to posterior instability) and radiographically at annual intervals for a mean of 10.5 years (range, eight to fourteen years).

Results: Forty-four (95%) of forty-six knees had a good or excellent result at a mean of 10.5 years. However, nine (13%) of the original seventy-two knees had revision of the implant, with six of the revisions performed because of failure of a metal‐backed patellar component. The rate of survival at ten years was 93% 4% with femoral or tibial revision for any reason as the end point and 81% 5% with any reoperation as the end point. There was no aseptic loosening in any knee. Posterior instability was identified clinically and/or radiographically in two (2.8%) of the original seventy-two knees; both unstable knees were in the same patient.

Conclusion: Posterior cruciate ligament-retaining total knee arthroplasty yielded satisfactory clinical and radiographic results in patients with rheumatoid arthritis at intermediate-term follow‐up (mean, 10.5 years). Therefore, we believe that it remains an excellent treatment option for these patients.

Michael J. Archibeck, MD; New Mexico Orthopaedics, 201 Cedar Street S.E., Suite 6600, Albuquerque, NM 87106

Richard A. Berger, MD; Regina M. Barden, RN; Joshua J. Jacobs, MD; Mitchell B. Sheinkop, MD; Aaron G. Rosenberg, MD; Jorge O. Galante, MD; Midwest Orthopaedics, Rush-Presbyterian-St. Luke’s Medical Center, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612

Copyright 2001 by The Journal of Bone and Joint Surgery, Incorporated
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