Tổng arthroplasty đầu gối ở bệnh nhân khớp dạng thấp những thách thức độc đáo, bao gồm cả tính chất hệ thống của các bệnh của bệnh nhân, sự hiện diện dị tật đáng kể mô mềm và osteopenic xương, và tăng nguy cơ biến chứng như chữa lành vết thương và co dai dẳng. | 31 31 Understanding the Rheumatoid Knee K. K. Anbari J. P. Garino Summary Preoperative Considerations and Planning Total knee arthroplasty in the rheumatoid patient presents unique challenges including the systemic nature of the patient s disease the presence of significant soft-tissue deformities and osteopenic bone and an increased risk of complications such as wound healing and persistent contractures. In order to maximize the probability of a successful outcome the surgeon must optimize the patient s pre-operative medical status pay meticulous attention to soft-tissue balancing and contracture release in the operating room and closely monitor the patient s postoperative course. Adherence to these principles optimizes the results of total knee arthroplasty in the rheumatoid patient making this a very rewarding procedure for both patient and surgeon. Introduction The knee joint is affected in approximately 90 of patients with chronic rheumatoid arthritis 1 . Total knee arthroplasty TKA provides the rheumatoid patient with substantial alleviation of pain and deformity. However the rheumatoid knee presents several challenges to the surgeon in the operating room as well as in the pre- and postoperative stages. Rheumatoid arthritis is a systemic disease that affects multiple organ systems and rheumatoid patients frequently take several immunosuppressive medications that must be addressed in the perioperative period. The surgeon encounters several important issues when planning knee arthroplasty including the timing of knee surgery relative to other arthritic joints and the choice of anesthesia. At the time of surgery the rheumatoid knee is characterized by osteopenic bone valgus deformity with a frequently incompetent medial collateral ligament and soft-tissue contractures. The level of constraint of the prosthesis is an important decision. Extreme care must be given to soft-tissue balancing. Postoperatively the rheumatoid patient may be affected by wound-healing .
