JBJS, August 1, 2001, Volume 83, Issue 8

Posterior Cruciate Ligament-Retaining Total Knee Arthroplasty in Patients with Rheumatoid Arthritis

Michael J. Archibeck, MD Richard A. Berger, MD Regina M. Barden, RN Joshua J. Jacobs, MD Mitchell B. Sheinkop, MD Aaron G. Rosenberg, MD Jorge O. Galante, MD

Knee

Background: Although initial reports on posterior cruciate ligament-retaining total knee arthroplasty in patients with rheumatoid arthritis have been encouraging, a high rate of late instability necessitating revision has been reported recently. The purpose of the present prospective study was to analyze the results of posterior cruciate ligament-retaining total knee arthroplasty in patients with rheumatoid arthritis.

Methods: Seventy‐two posterior cruciate ligament-retaining total knee arthroplasties in fifty‐one patients with rheumatoid arthritis were studied prospectively. All procedures were performed with the Miller-Galante I prosthesis. Eighteen patients (twenty-four knees) died before the eight-year follow‐up and one patient (two knees) was lost to follow-up, leaving forty-six knees (thirty-two patients) for review. These forty-six knees were evaluated clinically (with particular attention to posterior instability) and radiographically at annual intervals for a mean of 10.5 years (range, eight to fourteen years).

Results: Forty-four (95%) of forty-six knees had a good or excellent result at a mean of 10.5 years. However, nine (13%) of the original seventy-two knees had revision of the implant, with six of the revisions performed because of failure of a metal‐backed patellar component. The rate of survival at ten years was 93% 4% with femoral or tibial revision for any reason as the end point and 81% 5% with any reoperation as the end point. There was no aseptic loosening in any knee. Posterior instability was identified clinically and/or radiographically in two (2.8%) of the original seventy-two knees; both unstable knees were in the same patient.

Conclusion: Posterior cruciate ligament-retaining total knee arthroplasty yielded satisfactory clinical and radiographic results in patients with rheumatoid arthritis at intermediate-term follow‐up (mean, 10.5 years). Therefore, we believe that it remains an excellent treatment option for these patients.

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