Challenge of the Week / Knee / 09.13.19

A 56-year-old female patient presents complaining of bilateral knee pain along with bilateral hand pain. She reports greater pain and stiffness in the morning. Her radiographs show symmetrical joint space narrowing with periarticular erosions with diffuse osteopenia. Which of the following should be included in operative planning? 
  • Cessation of all medications 1 month prior to any surgical intervention
  • The perioperative management of rheumatological medications is an ever evolving concept. Several medications are now continued throughout the perioperative period.

  • A cervical spine evaluation with flexion and extension cervical spine imaging
  • The history and radiographs are consistent with an inflammatory process, such as rheumatoid arthritis. Patients with rheumatoid arthritis are at increased risk of cervical subaxial instability and basal invagination. A screening cervical spine radiograph is important prior to intubation or positioning during surgery.

  • Use of a posterior stabilized implant, as cruciate-retaining implants have an increased failure rate within the first 2 years
  • This is not true. Several studies have shown successful long term results with cruciate retaining implants in patients with rheumatoid arthritis.

  • Plan to administer double-coverage antibiotics
  • Patients with rheumatoid arthritis do have an increased rate of infection when compared to those undergoing a total knee arthroplasty for osteoarthritis; however, there is no data to support the alteration of perioperative antibiotics.

One thought on “Challenge of the Week / Knee / 09.13.19

  1. No symptoms of cervical radiculopathy. Today total joints should be preferably done under spinal anesth. No indication to evaluate cervical spine in this patient.
    RA patients have greater likelihood of PCL rupture long after total knee replacement. CR prosthesis is not the implant of choice.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.