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Bilateral hip and knee replacement for rheumatoid arthritis
The Journal of Bone and Joint Surgery. British Volume
|March 1, 1985
Summary
Total hip and knee replacement surgery effectively relieved pain and improved function in patients with severe rheumatoid arthritis. The preferred surgical order is hip replacement before knee replacement for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Reconstructive Surgery
Background:
- Severe rheumatoid arthritis often necessitates multiple joint replacements.
- The optimal sequence for bilateral hip and knee arthroplasty in rheumatoid arthritis patients is debated.
Purpose of the Study:
- To evaluate the outcomes of simultaneous bilateral hip and knee arthroplasty in patients with severe rheumatoid arthritis.
- To determine the preferred surgical sequence (hips before knees) and identify factors influencing success.
Main Methods:
- Retrospective review of 19 patients with severe rheumatoid arthritis undergoing bilateral hip and knee replacements.
- Mean follow-up of 27 months.
Main Results:
- All patients experienced pain relief.
- Functional improvement was observed in 17 out of 19 patients.
- Severe rheumatoid disease and pre-operative immobilization were not contraindications.
- Cervical myelopathy and severe upper limb deformity negatively impacted outcomes.
Conclusions:
- Bilateral hip and knee arthroplasty is effective for pain relief and functional improvement in severe rheumatoid arthritis.
- A hip-first surgical approach is preferred.
- Patient factors like cervical myelopathy and upper limb deformity should be considered.