Total knee arthroplasty in young adults who have rheumatoid arthritis

At the Mayo Clinic, between 1978 and 1982, forty-four total knee arthroplasties were performed with cement in twenty-six adults who had rheumatoid arthritis. The age at operation ranged from nineteen to thirty-nine years old. The twenty-six patients were followed for two to eight years (average, five years). At the time of final follow-up, thirty-nine knees were free of pain and five were mildly painful during weight-bearing. The Hospital for Special Surgery knee score improved from a mean of 52 points preoperatively to 84 points postoperatively. There were twenty-four excellent, fourteen good, six fair, and no poor results. Radiographic analysis revealed an incomplete radiolucent line that was more than one millimeter in width adjacent to five tibial and four femoral components in eight knees (18 per cent). The positions of the components had not changed. Postoperatively, there was one transient peroneal palsy and two knees required patellar resurfacing. No revisions were performed for loosening of a prosthesis. We concluded that use of a cemented total knee prosthesis in a patient who has rheumatoid arthritis and is less than forty years old provides a satisfactory result and that the component will not loosen after an average of five years.