Multiple replacements of major joints in rheumatoid arthritis

Multiple total joint replacements were performed in 51 handicapped rheumatoid patients. Three joints were replaced in 23 patients, four joints in 25 patients, five joints in one patient, and six joints in two patients, for a total of 186 replacements of elbow, hip, knee and ankle joints. By the time of followup, seven of the patients had died due to unrelated causes. Evaluation of the walking ability in the remaining 43 patients revealed that 20 out of 22 nonambulatory patients had become able to walk indoors and outdoors, and 21 patients who had been able to walk only indoors became able to walk outdoors as well. Major complications occurred in 11 patients: femoral neck fracture in three, supracondylar fracture of the femur in three, cervical myelopathy in two, and loosening of the femoral prosthesis in two patients. The factors responsible for poor results in two patients were cervical problems and loss of motivation.