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Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee

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Abstract

Purpose

Total knee arthroplasty (TKA) is a well-proven modality that can provide pain relief and restore mobility for rheumatoid arthritis (RA) patients with advanced joint destruction. Patellar ligament avulsion, especially in presence of poor bone quality and knee stiffness, is one of the special considerations that must be addressed in this unique population of patients. This study aimed to determine the functional results in a series of rheumatoid patients with stiff knee and end-stage joint destruction who underwent tibial tubercle osteotomy during TKA.

Methods

Twenty-three knees in 20 patients (16 women; four men) at a mean age of 54 years with end-stage arthritis and knee stiffness due to RA were operated upon for TKA using tibial tubercle osteotomy as a step during the operation. Patients were reviewed clinically and radiographically with a minimum follow-up of two years. Complications were noted. Hospital for Special Surgery (HSS) score was recorded pre-operatively and at six and 12 months postoperatively.

Results

Union occurred at the osteotomy site in 21 of 23 cases. One case had deep venous thrombosis (DVT). There was no infection or periprosthetic fracture, and at last follow-up, no patient required revision. HSS score improved from 46 (15–60) pre-operatively to 85 (71–96) post-operatively.

Conclusion

Tibial tubercle osteotomy during TKA in patients with RA and stiff knee is technically demanding yet proved to be effective in improving post-operative range of movement and minimising the complication of patellar ligament avulsion.

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Acknowledgments

No benefits or funds were received in support of this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Ahmed Salem Eid, Wael Ahmed Mohamed Nassar & Tamer Abdelmeguid Mohamed Fayyad

  2. Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University Hospitals, Ramses St, Abbaseya, Cairo, Egypt

    Ahmed Salem Eid

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  1. Ahmed Salem Eid
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  2. Wael Ahmed Mohamed Nassar
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  3. Tamer Abdelmeguid Mohamed Fayyad
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Correspondence to Ahmed Salem Eid.

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Eid, A.S., Nassar, W.A.M. & Fayyad, T.A.M. Total knee replacement with tibial tubercle osteotomy in rheumatoid patients with stiff knee. International Orthopaedics (SICOT) 40, 2289–2293 (2016). https://doi.org/10.1007/s00264-016-3167-6

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  • DOI: https://doi.org/10.1007/s00264-016-3167-6

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