Comparison of the results of bilateral total knee arthroplasty with and without patellar replacement for rheumatoid arthritis. A follow-up note.

Simultaneous bilateral total knee arthroplasty was performed in twenty-six patients who had rheumatoid arthritis, and a patellar replacement was performed concurrently in one randomly selected knee in each patient. A lateral retinacular release was performed in all knees. The patients were followed for at least six years (mean, 6.6 years; range, 6.0 to 7.5 years), and the postoperative status of the patients was evaluated with the knee score of The Hospital for Special Surgery. Pain on standing and on ascending or descending stairs as well as tenderness of the patellofemoral joint also were assessed. The over-all score and the individual scores for pain, function, range of motion, muscle strength, flexion contracture, and instability were not significantly different between the knees that had had a patellar replacement and those that had not. However, pain on standing and on ascending or descending stairs as well as tenderness of the patellofemoral joint were only noted in knees that had not had a patellar replacement. These findings suggest that, in order to diminish pain on standing and on using stairs, replacement of the patella during total knee arthroplasty is preferable for patients who have rheumatoid arthritis.

Total knee arthroplasty in Charcot's joint.

The authors report three cases with neuropathic (Charcot) knee joint due to tabes dorsalis in which total knee arthroplasty (TKA) was performed. Three cases (5 joints) were observed for more than 8 years after TKA. No ataxia was seen before or after surgery. The postoperative clinical course had been satisfactory in two cases (3 joints) for 9-10 years after TKA with no evidence of loosening. Although the other case had medial condylar fracture of the right upper tibia during postoperative treatment, the clinical course of the right knee had been satisfactory over the 7 years since revision arthroplasty using a tibial component with a long stem. This case also had loosening of the left tibial component 8 years after TKA. Total knee arthroplasty appears to be useful for the treatment of Charcot's joint with no ataxia at Eichenholtz' stage of coalescence and reconstruction if (1) proper surgical techniques to establish good ligamentous balancing and bony alignment by releasing ligaments are employed; (2) an adequate amount of bone is resected and remaining bony defects are reinforced with bone graft; (3) long-stem components are used on both the femoral and tibial sides.

[Clinical studies on 9 patients with Heberden's nodes of premenopausal onset].

Nine patients with Heberden's nodes of premenopausal onset were studied for complications in the form of thyroid disorders as well as from the hereditary, roentgenological and immunological aspects. In addition, rheumatoid arthritis, psoriatic arthritis, traumatic arthritis, erosive osteoarthritis or adult Still's disease was excluded in these patients. All patients had thyroid disorder (Basedow's disease in 6 patients, Hashimoto's thyroiditis in 2 patients and granular thyroiditis in one patient). Immunological examinations were positive for anti-thyroglobulin antibody in 5 patients and anti-microsome antibody in 3 patients and anti-nuclear antibody in 2 patients. Roentgenological findings revealed no typical signs of primary generalized osteoarthritis.

Patellar replacement in bilateral total knee arthroplasty. A study of patients who had rheumatoid arthritis and no gross deformity of the patella.

Thirty-five patients who had rheumatoid arthritis of both knees, but no gross deformity of the patella, had bilateral total knee arthroplasty. In each patient, one knee had a patellar replacement and the other did not. All of the patients were followed for a minimum of two years. The results were the same in both knees in terms of relief of pain and improvement in function, arc of motion, and muscle power. Although no complications that were related to patellar replacement developed in these patients, routine replacement of patellae that have little or no deformity does not seem advisable.

[A study on lymphocyte subsets of peripheral blood and synovial fluid using monoclonal antibodies in patients with rheumatoid arthritis].

Synovial fluid lymphocytes and paired peripheral blood lymphocytes from 29 patients with rheumatoid arthritis (RA) were analyzed using two-dimensional flow cytometry. The lymphocytes of peripheral blood from 20 normal subjects were served as control. In the RA patients, the composition of the lymphocyte population was different in the synovial fluid and peripheral blood. Compared with the peripheral blood, the synovial fluid contained higher populations of Ia+ (Leu 4 + Leu HLA-DR+) T cells, especially Leu 2a + Leu HLA-DR+ (activated suppressor/cytotoxic) T cells, and of Leu 2a + Leu 15- (cytotoxic T) cells and Leu 3a + Leu 8- (helper T) cells. Contrary, the synovial fluid contained lower populations of Leu 2a + Leu 15+ (suppressor T) cells and Leu 3a + Leu 8+ (inducer T) cells. Compared with the lymphocytes of the normal peripheral blood, the RA patients had an elevated ratio of helper T/suppressor T cells (Th/Ts) in both the synovial fluid and peripheral blood, incidentally the former group showed striking elevation. The ratio of Th/Ts in the synovial fluid showed considerable variation, with a significant inverse correlation with the disease activity (Lansbury index). These findings suggest that patients with rheumatoid arthritis show more specific changes in their synovial fluid lymphocytes than in their peripheral blood lymphocytes.