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Multiple joint replacement in chronically neglected polyarthritic patients: Two case reports.

Shrinand V Vaidya¹, Alaric Aroojis

¹Department of Orthopaedics, King Edward VII Memorial Hospital, Mumbai, India.

Journal of Orthopaedic Surgery (Hong Kong)

|December 7, 2002

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Multiple joint replacement offers a viable rehabilitation path for young polyarthritic patients. This surgical approach can restore mobility for individuals previously bedridden due to severe joint deformities and neglect.

Area of Science:

Orthopedic Surgery
Rheumatology
Rehabilitation Medicine

Background:

Young polyarthritic patients often face chronic neglect, leading to severe joint deformities like ankylosis and contractures.
These deformities, stemming from conditions such as ankylosing spondylitis and rheumatoid arthritis, significantly impair mobility and quality of life.
Associated spinal and thoracic cage involvement complicates anesthesia and patient positioning during surgical interventions.

Purpose of the Study:

To evaluate the efficacy of multiple joint replacement in rehabilitating young polyarthritic patients with neglected, unsalvageable joints.
To present surgical strategies and address challenges in managing patients with extreme deformities and long-term immobility.
To introduce a modified surgical technique for total hip replacement in cases of extreme external rotation ankylosis.

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Main Methods:

Phased surgical approach for multiple joint replacements in two young polyarthritic patients previously bedridden for 6-11 years.
Extensive pre- and post-operative rehabilitation programs.
Utilized a modified hip exposure technique avoiding trochanteric osteotomy for total hip replacement.

Main Results:

Both patients achieved unaided ambulation after phased multiple joint replacements and comprehensive rehabilitation.
The modified hip replacement technique proved valuable in managing extreme external rotation ankylosis.
Successfully navigated challenges related to anesthesia and positioning in patients with significant spinal and thoracic involvement.

Conclusions:

Multiple joint replacement is a successful and viable option for rehabilitating young polyarthritic patients suffering from chronic neglect and severe joint deformities.
The presented surgical modifications and management strategies offer guidance for complex cases.
Restoring mobility through joint replacement significantly improves the quality of life for neglected patient populations.