Complications of total knee arthroplasty and the development of late deep infection in patients with rheumatoid arthritis

Abstract

Aim: This study aimed to assess complications and the presence of late deep infection in patients with rheumatoid arthritis (RA) who underwent primary and revision total knee arthroplasty (TKA). Materıial and Method: Between June 1997 and October 2022, cemented TKA that cut the posterior cruciate ligament (PCL) was applied to 50 knees of 34 patients with RA, and posterior-stabilized (PS) revision TKA was applied to 7 knees of 5 patients. All the patients enclosed in this study were adults diagnosed with RA by a rheumatology or physical therapy physician according to the RA diagnostic criteria recommended by the American College of Rheumatology in 1987. The diagnosis of infection was based on the Periprosthetic Infection Diagnostic Criteria of the 2018 International Periprosthetic Joint Infections Consensus Meeting. Results: Complications were found in 9 (18%) of the 50 knees who underwent primary TKA. Postoperative serous discharge was observed in 3 (6%) knees, serous discharge and late partial rupture of the quadriceps tendon in 1 (2%), early deep infection in 1 (2%), late deep infection in 3 (6%), and hematoma in 1 (2%). Revision surgery was performed on 3 (6%) knees due to infection and on 4 (8%) knees due to aseptic loosening. Complications developed in 2 of these knees who underwent revision TKA, 1 (14.3%) knee with periprosthetic fracture in the femur in the first postoperative year, and 1 (14.3%) knee with early deep infection. Deep vein thrombosis (DVT), pulmonary emboli (PE) and heterotopic ossification (HO) were not observed in any patient. Conclusion: In patients with rheumatoid arthritis, total knee arthroplasty increased chronic late deep infection and the associated need for revision surgery, and decreased the rates of DVT, PE, HO.