Skip to main content

Advertisement

SpringerLink
Log in

Clinical Results of Bone Ingrowth TKA in Patients with Rheumatoid Arthritis

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Patients with rheumatoid arthritis (RA) often are not considered for TKA with bone ingrowth fixation because of poor bone quality, but we asked whether implants with sintered metal bead surfaces could be used to durably fix implants in this group of patients. We prospectively evaluated a consecutive series of 47 patients (64 knees) between January 1, 1994, and December 30, 2001, in two separate medical centers using one TKA system. Standard primary implants were used in all knees except those with major bone defects, and in these patients we used long diaphyseal stems to stabilize the implants. Minimum followup was 61 months (mean ± standard deviation, 83 ± 6 months; range, 61–124 months). Survivorship was 98.4% at 10 years postoperatively. No components failed because of loosening. One femoral component was revised for fracture because of a massive intraosseous rheumatoid cyst. No knees had radiographic evidence of migration or widening radiolucent lines. Knee Society clinical, pain, and function scores improved after surgery and were maintained throughout followup. These data suggest bone ingrowth implants can provide durable fixation in patients with RA.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Armstrong RA, Whiteside LA. Results of cementless total knee arthroplasty in an older rheumatoid arthritis population. J Arthroplasty. 1991;6:357–362.

    Article  PubMed  CAS  Google Scholar 

  2. Bartel DL, Burstein AH, Santavicca EA, Insall JN. Performance of the tibial component in total knee replacement. J Bone Joint Surg Am. 1982;64:1026–1033.

    PubMed  CAS  Google Scholar 

  3. Buechel FF Sr, Buechel FF Jr, Pappas MJ, D’Alessio J. Twenty-year evaluation of meniscal bearing and rotating platform knee replacements. Clin Orthop Relat Res. 2001;388:41–50.

    Article  PubMed  Google Scholar 

  4. Carmichael E, Chaplin DM. Total knee arthroplasty in juvenile rheumatoid arthritis: a seven-year follow-up study. Clin Orthop Relat Res. 1986;210:192–200.

    PubMed  Google Scholar 

  5. Crowder AR, Duffy GP, Trousdale RT. Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis. J Arthroplasty. 2005;20(7 suppl 3):12–16.

    Article  PubMed  Google Scholar 

  6. Dorr LD, Ranawat CS, Sculco TA, McKaskill B, Orisek BS. Bone graft for tibial defects in total knee arthroplasty. Clin Orthop Relat Res. 1986;205:153–165.

    PubMed  Google Scholar 

  7. Ebert FR, Krackow KA, Lennox DW, Hungerford DS. Minimum 4-year follow-up of the PCA total knee arthroplasty in rheumatoid patients. J Arthroplasty. 1992;7:101–108.

    Article  PubMed  CAS  Google Scholar 

  8. Gill GS, Joshi AB. Long-term results of retention of the posterior cruciate ligament in total knee replacement in rheumatoid arthritis. J Bone Joint Surg Br. 2001;83:510–512.

    Article  PubMed  CAS  Google Scholar 

  9. Himanen AK, Belt E, Nevalainen J, Hamalainen M, Lehto MU. Survival of the AGC total knee arthroplasty is similar for arthrosis and rheumatoid arthritis: Finnish Arthroplasty Register report on 8,467 operations carried out between 1985 and 1999. Acta Orthop. 2005;76:85–88.

    Article  PubMed  Google Scholar 

  10. Hofmann AA, Evanich JD, Ferguson RP, Camargo MP. Ten- to 14-year clinical followup of the cementless Natural Knee system. Clin Orthop Relat Res. 2001;388:85–94.

    Article  PubMed  Google Scholar 

  11. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.

    PubMed  Google Scholar 

  12. Kaplan E, Meier P. Nonparametric estimation from incomplete data. J Am Stat Assoc. 1958;53:457–481.

    Article  Google Scholar 

  13. Knutson K, Tjornstrand B, Lidgren L. Survival of knee arthroplasties for rheumatoid arthritis. Acta Orthop Scand. 1985;56:422–425.

    PubMed  CAS  Google Scholar 

  14. Levine B, Sporer S, Della Valle CJ, Jacobs JJ, Paprosky W. Porous tantalum in reconstructive surgery of the knee: a review. J Knee Surg. 2007;20:185–194.

    PubMed  Google Scholar 

  15. Nilsson KG, Karrholm J, Ekelund L, Magnusson P. Evaluation of micromotion in cemented vs uncemented knee arthroplasty in osteoarthrosis and rheumatoid arthritis: randomized study using roentgen stereophotogrammetric analysis. J Arthroplasty. 1991;6:265–278.

    Article  PubMed  CAS  Google Scholar 

  16. Pandit H, Aslam N, Pirpiris M, Jinnah R. Total knee arthroplasty: the future. J Surg Orthop Adv. 2006;15:79–85.

    PubMed  Google Scholar 

  17. Polzin B, Ellis T, Dirschl DR. Effects of varying pulsatile lavage pressure on cancellous bone structure and fracture healing. J Orthop Trauma. 2006;20:261–266.

    Article  PubMed  Google Scholar 

  18. Ritter MA, Sieber JM. The effects of pulsed fluid irrigation on bony ingrowth in porous polyethylene implants. Orthopedics. 1987;10:285–288.

    PubMed  CAS  Google Scholar 

  19. Robertsson O, Knutson K, Lewold S, Goodman S, Lidgren L. Knee arthroplasty in rheumatoid arthritis: a report from the Swedish Knee Arthroplasty Register on 4,381 primary operations 1985–1995. Acta Orthop Scand. 1997;68:545–553.

    Article  PubMed  CAS  Google Scholar 

  20. Rodriguez JA, Saddler S, Edelman S, Ranawat CS. Long-term results of total knee arthroplasty in class 3 and 4 rheumatoid arthritis. J Arthroplasty. 1996;11:141–145.

    Article  PubMed  CAS  Google Scholar 

  21. Schai PA, Scott RD, Thornhill TS. Total knee arthroplasty with posterior cruciate retention in patients with rheumatoid arthritis. Clin Orthop Relat Res. 1999;367:96–106.

    PubMed  Google Scholar 

  22. Schroder HM, Aaen K, Hansen EB, Nielsen PT, Rechnagel K. Cementless total knee arthroplasty in rheumatoid arthritis: a report on 51 AGC knees followed for 54 months. J Arthroplasty. 1996;11:18–23.

    Article  PubMed  CAS  Google Scholar 

  23. Scuderi GR, Insall JN, Windsor RE, Moran MC. Survivorship of cemented knee replacements. J Bone Joint Surg Br. 1989;71:798–803.

    PubMed  CAS  Google Scholar 

  24. Sharma S, Nicol F, Hullin MG, McCreath SW. Long-term results of the uncemented low contact stress total knee replacement in patients with rheumatoid arthritis. J Bone Joint Surg Br. 2005;87:1077–1080.

    Article  PubMed  CAS  Google Scholar 

  25. Sorrells RB, Capps SG. Clinical results of primary low contact stress cementless total knee arthroplasty. Orthopedics. 2006;29(9 suppl):S42–S44.

    PubMed  Google Scholar 

  26. Whiteside LA. The effect of patient age, gender, and tibial component fixation on pain relief after cementless total knee arthroplasty. Clin Orthop Relat Res. 1991;271:21–27.

    PubMed  Google Scholar 

  27. Whiteside LA. Cementless total knee replacement: nine- to 11-year results and 10-year survivorship analysis. Clin Orthop Relat Res. 1994;309:185–192.

    PubMed  Google Scholar 

  28. Whiteside LA. Long-term followup of the bone-ingrowth Ortholoc knee system without a metal-backed patella. Clin Orthop Relat Res. 2001;388:77–84.

    Article  PubMed  Google Scholar 

  29. Whiteside LA, McCarthy DS. Fixation of the Quatroloc femoral component: a biomechanical and clinical study. Clin Orthop Relat Res. 2001;393:147–156.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Diane Morton, MS, for assistance with manuscript preparation.

Author information

Authors and Affiliations

  1. Istituto Ortopedico Gaetano Pini—Milano, Milan, Italy

    Roberto Viganó MD

  2. Missouri Bone and Joint Center, St. Louis, MO, USA

    Leo A. Whiteside MD

  3. Missouri Bone and Joint Research Foundation, 1000 Des Peres Rd., Suite 150, St. Louis, MO, 63131, USA

    Leo A. Whiteside MD & Marcel Roy PhD

Authors
  1. Roberto Viganó MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leo A. Whiteside MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcel Roy PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leo A. Whiteside MD.

Additional information

One or more authors (LAW) have received funding from Smith & Nephew, Inc, Memphis, TN.

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

About this article

Cite this article

Viganó, R., Whiteside, L.A. & Roy, M. Clinical Results of Bone Ingrowth TKA in Patients with Rheumatoid Arthritis. Clin Orthop Relat Res 466, 3071–3077 (2008). https://doi.org/10.1007/s11999-008-0394-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0394-1

Keywords

Search

Navigation