Early appearance of radiolucent lines around total knee arthroplasty in rheumatoid arthritis patients. How does it impact the aseptic failure rate and functional outcomes at 13 years of follow-up?

INTRODUCTION

Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or >2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up.

METHODS

We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up.

RESULTS

The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines.

CONCLUSIONS

Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.

Early appearance of radiolucent lines around total knee arthroplasty in rheumatoid arthritis patients. How does it impact the aseptic failure rate and functional outcomes at 13 years of follow-up?

INTRODUCTION

Aseptic total knee arthroplasty (TKA) failure has been associated with radiolucent lines. This study aimed to determine the impact of the early appearance of radiolucent lines (linear images of 1, 2, or > 2mm at the cement-bone interface) around the TKA on prosthetic survival and functional outcomes in rheumatoid arthritis (RA) patients during a 2-20 years follow-up.

METHODS

We retrospectively analyzed a consecutive series of RA patients treated with TKA between 2000 and 2011. We comparatively analyzed patients with and without radiolucent lines around implants. Clinical outcomes were assessed with the knee society score (KSS) collected before surgery, at years 2, 5, and 10, and at the last postoperative follow-up. The knee society roentgenographic evaluation system was used to analyze the impact of radiolucent lines around the implants at 1, 2, 5, and more than ten years of follow-up. The reoperation and prosthetic survival rates were calculated at the end of the follow-up.

RESULTS

The study series included 72 TKAs with a median follow-up of 13.2 years (range: 4.0-21.0), of which 16 (22.2%) had radiolucent lines. We did not observe aseptic failure, and prosthetic survival at the end of the study was 94.4% (n=68). The KSS improved significantly (p<0.001) between preoperative values at 2, 5, and 10 years and the end of follow-up, with no differences between patients with and without radiolucent lines.

CONCLUSIONS

Our study demonstrates that the early appearance of radiolucent lines around a TKA in RA patients does not significantly impact prosthetic survival or long-term functional outcomes at 13 years of follow-up.

Arthroplasty as a treatment for acute and quiescent septic arthritis in native hips

INTRODUCTION

The most feared complication in hip arthroplasty after septic arthritis is septic failure. It is considered that the two-stage treatment is the accepted treatment for acute septic hip arthritis. The objective in this work is to establish a therapeutic guideline for septic arthritis in native hips, proposing a two-stage treatment for acute, and a one-stage treatment for quiescent.

MATERIAL AND METHODS

Observational, descriptive, retrospective study. We analyzed all patients who underwent total primary hip replacement between June 1997 and June 2016. We selected those patients who had a diagnosis of septic arthritis of the hip prior to surgery (group 1: acute septic arthritis; group 2: quiescent septic arthritis).

RESULTS

Eight hips in group 1 with a follow-up of one to six years. Each patient fulfilled the antibiotic treatment between the placement of the spacer and the definitive prosthetic replacement, and, in all the cases, the remission of the infection was verified. On the other hand, 12 hips in group 2, the time between the treated infection and the prosthetic replacement varied between five and 46 years. The femoral heads sent to culture were in all cases negative.

CONCLUSIONS

In the last 20 years, we have obtained satisfactory results, both in the treatment of acute septic arthritis and in its sequelae, interpreting them as pathologies of the same origin but with a different treatment. Both treatments are adequate, as long as the therapeutic protocol established for each of the groups is respected.