Cervical myelopathy complicating multiple joint replacement in rheumatoid disease

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Neurology

Background:

• Rheumatoid disease frequently affects multiple joints, necessitating joint replacement surgery.
• Cervical spine involvement, including myelopathy and subluxation, is a known complication in rheumatoid arthritis.
• The impact of extensive lower limb joint replacement on cervical spine health in rheumatoid disease is not well-defined.

Purpose of the Study:

• To investigate the incidence of cervical myelopathy and subluxation in patients with rheumatoid disease after major lower limb joint replacement.
• To compare the incidence of cervical spine complications in this patient group with a control population.
• To identify predictors for the development of cervical myelopathy and subluxation.

Main Methods:

• Retrospective study of 48 patients with rheumatoid disease who underwent three or more major lower limb joint replacements.
• Radiographic assessment of cervical spine subluxation.
• Clinical evaluation for cervical myelopathy.
• Comparison with 51 control patients.

Main Results:

• 17% of patients developed cervical myelopathy, with two cases leading to death.
• 66% of patients had cervical subluxation.
• Cervical myelopathy incidence was significantly higher (p<0.05) in the joint replacement group compared to controls (4%).
• Cervical spine changes were independent of lower limb joint destruction and clinical predictors were not identified.

Conclusions:

• Patients with rheumatoid disease undergoing multiple lower limb joint replacements have an increased risk of cervical myelopathy and subluxation.
• Cervical spine complications can occur independently of lower limb joint disease severity.
• Further research is needed to understand the mechanisms and develop predictive models for cervical complications.