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

Area of Science:

• Orthopedics
• Rheumatology
• Surgical Innovation

Background:

• Proximal tibial fractures present management challenges in rheumatoid arthritis (RA) patients.
• Rheumatoid arthritis can lead to insufficiency fractures, complicating treatment.
• Acute total knee replacement is explored as a treatment option.

Purpose of the Study:

• To evaluate the clinical outcomes of acute total knee replacement in RA patients with proximal tibial fractures.
• To assess functional results, pain severity, and patient-reported outcomes.

Main Methods:

• A case series of 11 RA patients with simultaneous proximal tibial insufficiency fractures.
• Treatment involved acute total knee replacement.
• Evaluation included midterm functional results using Hospital for Special Surgery (HSS) and Knee Society Score (KSS), pain severity, and Tegner activity scale.

Main Results:

• Significant improvement in Tegner activity scale (2.2 to 4.3, p<0.001).
• High KSS scores (knee: 88.7, function: 59.4) with excellent outcomes in 54.5% (knee) and 36.3% (function).
• Marked reduction in pain severity (65.2 to 35.5, p=0.02) and improvement in HSS scale (42 to 78, p<0.001).
• Return to normal activity averaged 5.5 months; deep vein thrombosis occurred in 2 patients.

Conclusions:

• Acute total knee replacement demonstrates excellent clinical outcomes for RA patients with proximal tibial fractures.
• The procedure leads to significant functional recovery and pain reduction.
• Total knee replacement facilitates a rapid return to normal activities in this patient cohort.