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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 1999 December;50(6):209-16
Follow-up after more than 15 and 10 years of knee arthroplasties in rheumatoid arthritis
Gualtieri G., Bertaiola F.
Background. The aim of the study is to evaluate the long-term results of knee arthroplasties in patients with rheumatoid arthritis.
Methods. Personal experience in six hundred and thirty-two total knee arthroplasties in rheumatoid patients starting from October 1976 until December 1998, is presented.
In order to know the long-term results, the patients have been divided into two groups:
‹ the first group includes patients operated more than 15 years ago (1976-1982). It consists of 46 first implantations with 25 follow-ups (54.3%);
‹ the second group includes patients operated more than 10 years ago (1983-1987). It consists of 110 first implantations with 87 follow-ups (79%).
No infections at the present time.
The study has been carried out following the control protocol for knee arthroplasties of the ERASS.
Results. To assess the results of these prostheses in rheumatoid arthritis, the authors have not used a score method with evaluation, for example walking ability or getting up and down the stairs, since other simultaneously affected joints of the lower limbs can affect the evaluation of the results.
The authors preferred a method including only specific parameters referring to the prosthesis. If a comparison is made of the excellent and good results between the Freeman ICLH implanted for more than ten years (70.3%) and the Freeman-Samuelson Mark II (90.6%) the percentage difference is 20.3%. Besides, the percentage difference between the excellent and good results of the same prosthesis (Freeman ICLH) implanted more than 15 (62.5%) and 10 (70.5%) years ago is only 7.8%.
Conclusions. The conclusion is drawn that the most decisive factors for the survival of an implantation are the biomechanical evolution of the prostheses and the improvement of the bone fixation technique rather than other factors such as, for example in rheumatoid arthritis, osteoporosis and steroid drugs.