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Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases

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Modern Rheumatology

Abstract

The treatment of patients with severe flexion contracture of the rheumatoid knee, deprived of ambulation for long periods of time, is challenging. Based on three cases, we indicate the potential risks of posterior dislocation of the knee after total knee arthroplasty. In this pathological condition, surgeons must carefully select the type of implant in order to avoid this serious complication. We also emphasize the importance of working on disuse muscle atrophy of trunk (back, abdominal) and lower limbs, both of which play an integral role in ambulation. The personality of each rheumatoid patient should be carefully considered when considering surgical and rehabilitation options.

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References

  1. Lu H, Mow CS, Lin J. Total knee arthroplasty in the presence of severe flexion contracture. J Arthroplasty. 1999;14:775–80.

    Article  PubMed  CAS  Google Scholar 

  2. Tateishi H. Contracture of the knee joint. J Joint Surg. 1985;4:361–5 (in Japanese).

    Google Scholar 

  3. Tanzer M, Miller J. The natural history of flexion contracture in total knee arthroplasty. Clin Orthop Relat Res. 1989;248:129–34.

    PubMed  Google Scholar 

  4. Laskin RW, Beksac B. Assess and achieve maximal extension. In: Bellemans J, Ries MD, Victor J, editors. Total knee arthroplasty. Heidelberg: Springer; 2005. p. 194–7.

    Chapter  Google Scholar 

  5. Abe S, Terashima Y, Koyama K, Tomioka M, Nakagawa N, Saegusa Y. Variety of gap kinematics in vivo at total knee arthroplasty for rheumatoid knee. J Bone Joint Surg. 2004; 86B (Suppl):322.

    Google Scholar 

  6. Laskin RS, O’Flynn HM. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications. Clin Orthop Relat Res. 1997;345:24–8.

    Google Scholar 

  7. McAuley JP, Engh GA. Constraint in total knee arthroplasty: when and what? J Arthroplasty. 2003;18:51–4.

    Article  PubMed  Google Scholar 

  8. Archibeck MJ, Berger RA, Barden RM, Jacobs JJ, Shenkop MB, Rosenberg AG, et al. Posterior cruciate ligament-retaining total knee arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg. 2001;83A:1231–6.

    Google Scholar 

  9. Haas SB, Insall JN, Montgomery W. Revision total knee arthroplasty with use of modular components with stems inserted without cement. J Bone Joint Surg. 1995;77A:1700–5.

    Google Scholar 

  10. Callaghan J, O’rourke M, Liu S. The role of implant constraint in revision total knee arthroplasty. Not too little, not too much. J Arthroplasty. 2005;20:41–3.

    Article  PubMed  Google Scholar 

  11. Barrack RL. Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res. 2001;392:292–9.

    Article  PubMed  Google Scholar 

  12. Lombardi AV, Mallory TH, Vaughn BK, Krugel R, Honkala TK, Sorscher M, et al. Dislocation following posterior-stabilized total knee arthroplasty. J Arthroplasty. 1993;8:633–9.

    Article  PubMed  Google Scholar 

  13. Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y. Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine. 1988;13:1317–26.

    Article  PubMed  CAS  Google Scholar 

  14. Haller C, Holzner B, Mur E, Gunther V. The impact of life events on patients with rheumatoid arthritis: a psychological myth? Clin Exp Rheumatol. 1997;15:175–9.

    PubMed  CAS  Google Scholar 

  15. Main CJ, Watson PJ. Psychological aspects of musculoskeletal pain. In: Hutson M, Ellis R, editors. Textbook of musculoskeletal medicine. 1st ed. New York: Oxford University Press; 2006. p. 97–107.

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We declare that there are no financial or other relationships that could lead to a conflict of interest.

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Correspondence to Shuji Abe.

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Abe, S., Kohyama, K., Yokoyama, H. et al. Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases. Mod Rheumatol 18, 499–506 (2008). https://doi.org/10.1007/s10165-008-0079-3

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  • DOI: https://doi.org/10.1007/s10165-008-0079-3

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