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HomeReview of the conditionConsidering surgeryTypes of surgery recommended Who should consider knee surgery for rheumatoid arthritis?What happens without surgery?Surgical options Effectiveness Urgency Risks Managing risk Preparing for surgeryAbout the procedureRecovering from surgeryRehabilitationConclusion

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Knee Surgery for Rheumatoid Arthritis.

Last updated Thursday, February 10, 2005

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Considering surgery

Types of surgery recommended

Who should consider knee surgery for rheumatoid arthritis?

RA patients who have unrelenting knee pain and destructive arthritis of their knee joint that does not respond favorably to medical management should consider total knee replacement. RA patients with knee involvement in early stages, who do not yet have destructive arthritis, yet have pain and synovitis that does not respond to medical managementun should consider knee arthroscopy.

What happens without surgery?

The best case scenario includes inactivity and decreased mobility in conjunction with antirheumatic medication and intraarticular steroids can cause some improvement of symptoms.

A worst case scenario might be severe destruction of the knee joint and associated osteoporosis and reduced physical capacity potentially leading to a compromised knee replacement at a later stage with a less predictable outcome.

Surgical options

In early stages, arthroscopic or open synovectomy can be of benefit. In later stages, when the joint space has been destroyed, bony destruction and deformity has occurred and knee stiffness has set in, total knee replacement is the optimal and most reliable treatment.

Effectiveness

Knee replacements in RA are extremely successful. More than 80% of patients will have a satisfactory result for 12-15 years.

Urgency

Knee replacement surgery is an elective procedure and should be done only after non-surgical medical management has failed. Once indicated, postponing the surgery for an extended period of time (months or years) only leads to increased disability, disuse osteoporosis, and skeletal complications that can make surgery more difficult and potentially compromise the final result.

Risks

Infection, component failure and nerve damage are the most serious complications. Infection occurs in approximately 4% of patients with RA which is higher than in the osteoarthritis patient population. This is thought to be due to systemic immune compromise, frail skin and impaired wound healing. Peroneal nerve injury can occur with correction of severely deformed knees. Postoperative stiffness is common and may be aggravated by generalized muscular weakness and disability.

Managing risk

These complications can necessitate a revision knee replacement. If an infection occurs then the prosthesis needs to be removed. A six week period of antibiotic treatment is needed and if the infection is cured a revision knee replacement can be done. Wound complications may require additional surgery. Nerve injuries are managed by special knee positioning and modified rehabilitation.

Surgery for Rheumatoid arthritis of the knee at the University of Washington

If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.

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