EFFECTIVENESS OF BILATERAL TOTAL HIP AND KNEE ARTHROPLASTY FOR SEVERE INFLAMMATORY ARTHROPATHIES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIXin , LIHeng , NIMing , LIXiang , SONGXinggui , KONGXiangpeng , LIYucong ,  CHENJiying

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

CHENJiying, Email: chenjiying_301@163.com

Keywords：

Inflammatory arthropathy; Rheumatoid arthritis; Ankylosing spondylitis; Total hip arthroplasty; Total knee arthroplasty

DOI：

10.7507/1002-1892.20160278

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Objective To evaluate the application and effectiveness of bilateral total hip arthroplasty and total knee arthroplasty in the treatment of severe inflammatory arthropathies. Methods Between September 2008 and September 2015, 31 patients with severe inflammatory arthropathies were treated with bilateral total hip arthroplasty and total knee arthroplasty. Of 31 cases, 22 were male and 9 were female with an average age of 30 years (range, 20 to 41 years); there were 15 cases of rheumatoid arthritis and 16 cases of ankylosing spondylitis with an average onset age of 14 years (range, 5-28 years); all 4 ankylosed joints were observed in 11 cases, 3 ankylosed joints in 2 cases, 2 ankylosed joints in 6 cases, 1 ankylosed joint in 1 case, and no ankylosed joint in 11 cases. Before operation, the hip range of motion (ROM) value was (17.82±28.18)°, and the knee ROM value score was (26.45±30.18)°; the hip Harris score was 29.64±11.58, and the hospital for special surgery (HSS) score was 27.07±11.04. The patients were grouped and compared in accordance with etiology and ankylosed joint. Results One-stage arthroplasty was performed in 1 case, two-stage arthroplasty in 22 cases, three-stage arthroplasty in 7 cases, and four-stage arthroplasty in 1 case. The total operation time was 325-776 minutes; the total blood loss was 900-3 900 mL; the total transfusion volume was 2 220-8 070 mL; and the total hospitalization time was 21-65 days. The patients were followed up 12-94 months (mean, 51 months). The hip and knee ROM values, Harris score and HSS score at last follow-up were significantly improved when compared with preoperative ones (P < 0.05). The subjective satisfaction degree was good in 16 cases, moderate in 10 cases, and poor in 5 cases. Periprosthetic infection occurred in 2 cases (3 knees), joint stiffness in 3 cases (6 knees), joint instability in 1 case (1 knee), leg length discrepancy of > 2 cm in 2 cases, and flexion deformity of 10° in 1 case (1 knee). The hip and knee ROM values, Harris score and HSS score showed no significant difference between patients with ankylosing spondylitis and patients rheumatoid arthritis at last follow-up (P > 0.05). The hip and knee ROM values of the patients with ankylosed joint were significantly lower than those of patients with no ankylosed joint (P < 0.05); the Harris score and HSS score of the patients with ankylosed joint were lower than those of patients with no ankylosed joint, but no significant difference was found (P > 0.05). Conclusion A combination of bilateral hip and knee arthroplasty is an efficient treatment for severe lower extremities deformity, arthralgia and poor quality of life caused by inflammatory arthropathies. However, the postoperative periprosthetic infection and stiffness of knee are important complications influencing the effectiveness of operation.

Citation： LIXin, LIHeng, NIMing, LIXiang, SONGXinggui, KONGXiangpeng, LIYucong, CHENJiying. EFFECTIVENESS OF BILATERAL TOTAL HIP AND KNEE ARTHROPLASTY FOR SEVERE INFLAMMATORY ARTHROPATHIES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1358-1365. doi: 10.7507/1002-1892.20160278 Copy

1.	Goldring SR, Purdue PE, Crotti TN, et al. Bone remodelling in inflammatory arthritis. Ann Rheum Dis, 2013, 72 Suppl 2: ii52-56.
2.	Goodman SM, Figgie M. Lower extremity arthroplasty in patients with inflammatory arthritis: preoperative and perioperative management. J Am Acad Orthop Surg, 2013, 21(6): 355-363.
3.	边焱焱, 翁习生, 林进, 等.多关节置换治疗晚期下肢关节疾患.中国修复重建外科杂志, 2012, 26(3): 296-299.
4.	Feng DX, Zhang K, Zhang YM, et al. Bilaterally primary cementless total hip arthroplasty for severe hip ankylosis with ankylosing spondylitis. Orthop Surg, 2016, 8(3): 352-359.
5.	Heyse TJ, Ries MD, Belleman J, et al. Total knee arthroplasty in patients with juvenile idiopathic arthritis. Clin Orthop Relat Res, 2014, 472(1): 147-154.
6.	Jergesen HE, Poss R, Sledge CB. Bilateral total hip and knee replacement in adults with rheumatoid arthritis: an evaluation of function. Clin Orthop Relat Res, 1978, (137): 120-128.
7.	陈继营, 王岩, 周勇刚, 等. 3个以上大关节同期置换围手术期安全性分析.中国矫形外科杂志, 2008, 16(10): 739-741.
8.	Fisher KA, Fisher DA. Total hip and knee replacement in a patient with arthrogryposis multiplex congenital. Am J Orthop (Belle Mead NJ), 2014, 43(4): E79-82.
9.	Zink A, Braun J, Listing J, et al. Disability and handicap in rheumatoid arthritis and ankylosing spondylitis-results from the German rheumatological database. J Rheumatol, 2000, 27(3): 613-622.
10.	栗占国, 唐福林.凯莉风湿病学. 8版.北京:北京大学医学出版社, 2011: 587-596.
11.	Garvin KL, Pellicci PM, Windsor RE, et al. Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip. J Bone Joint Surg (Am), 1989, 71(9): 1355-1362.
12.	吕厚山, 陈晓欣, 林剑浩, 等.类风湿性关节炎下肢畸形手术顺序选择的初步经验.中华骨科杂志, 1995, 15(8): 483-486.
13.	Tang WM, Chiu KY. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty, 2000, 15(1): 52-58.
14.	郑润龙, 黄迅悟.人工膝关节置换假体的选择.中国医疗设备, 2015, 30(10): 20-24.
15.	Boussofara M, Hamdi M, Mtaallah MH, et al. Combined lumbar plexus and sciatic nerve block in hip arthroplasty with severe ankylosing spondylitis. Tunis Med, 2013, 91(3): 223-224.
16.	Tang WM, Chiu KY, Kwan MF, et al. Sagittal pelvic mal-rotation and positioning of the acetabular component in total hip arthroplasty: Three-dimensional computer model analysis. J Orthop Res, 2007, 25(6): 766-771.
17.	童培建.复杂人工膝关节置换.北京:人民卫生出版社, 2011: 19-26.
18.	Mitsuyasu H, Matsuda S, Miura H, et al. Flexion contracture persists if the contracture is more than 15° at 3 months after total knee arthroplasty. J Arthroplasty, 2011, 26(4): 639-643.
19.	Chung HK, Choi CH, Choi YJ, et al. Total knee replacement in severe flexion contracture. J Korean Knee Soc, 1997, 32: 1039-1046.
20.	张亮, 徐辉, 郭晓忠, 等.人工全髋关节置换术治疗强直性脊柱炎的中期疗效.中国修复重建外科杂志, 2014, 28(1): 1-6.
21.	Ravi B, Escott B, Shah PS, et al. A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum, 2012, 64(12): 3839-3849.
22.	宋凯, 张永刚, 付君, 等.脊柱矫形对强直性脊柱炎胸腰段后凸畸形患者髋关节相关活动能力及生活质量的影响.中国脊柱脊髓杂志, 2015, 25(10): 871-882.
23.	曾勇, 何睿, 李庆, 等.脊柱楔形截骨并人工全髋关节置换术治疗强直性脊柱炎后凸畸形并髋关节重度屈曲挛缩畸形.中国修复重建外科杂志, 2014, 28(8): 942-946.
24.	Gehrke T, Kendoff D, Haasper C. The role of hinges in primary total knee replacement. Bone Joint J, 2014, 96-B(11 Supple A): 93-95.
25.	Xu X, Shen B, Zhang A, et al. Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis. Patient Prefer Adherence, 2016, 10: 879-885.
26.	Durmus D, Sarisoy G, Alayli G, et al. Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue. Compr Psychiatry, 2015, 62(10): 170-177.

1. Goldring SR, Purdue PE, Crotti TN, et al. Bone remodelling in inflammatory arthritis. Ann Rheum Dis, 2013, 72 Suppl 2: ii52-56.
2. Goodman SM, Figgie M. Lower extremity arthroplasty in patients with inflammatory arthritis: preoperative and perioperative management. J Am Acad Orthop Surg, 2013, 21(6): 355-363.
3. 边焱焱, 翁习生, 林进, 等.多关节置换治疗晚期下肢关节疾患.中国修复重建外科杂志, 2012, 26(3): 296-299.
4. Feng DX, Zhang K, Zhang YM, et al. Bilaterally primary cementless total hip arthroplasty for severe hip ankylosis with ankylosing spondylitis. Orthop Surg, 2016, 8(3): 352-359.
5. Heyse TJ, Ries MD, Belleman J, et al. Total knee arthroplasty in patients with juvenile idiopathic arthritis. Clin Orthop Relat Res, 2014, 472(1): 147-154.
6. Jergesen HE, Poss R, Sledge CB. Bilateral total hip and knee replacement in adults with rheumatoid arthritis: an evaluation of function. Clin Orthop Relat Res, 1978, (137): 120-128.
7. 陈继营, 王岩, 周勇刚, 等. 3个以上大关节同期置换围手术期安全性分析.中国矫形外科杂志, 2008, 16(10): 739-741.
8. Fisher KA, Fisher DA. Total hip and knee replacement in a patient with arthrogryposis multiplex congenital. Am J Orthop (Belle Mead NJ), 2014, 43(4): E79-82.
9. Zink A, Braun J, Listing J, et al. Disability and handicap in rheumatoid arthritis and ankylosing spondylitis-results from the German rheumatological database. J Rheumatol, 2000, 27(3): 613-622.
10. 栗占国, 唐福林.凯莉风湿病学. 8版.北京:北京大学医学出版社, 2011: 587-596.
11. Garvin KL, Pellicci PM, Windsor RE, et al. Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip. J Bone Joint Surg (Am), 1989, 71(9): 1355-1362.
12. 吕厚山, 陈晓欣, 林剑浩, 等.类风湿性关节炎下肢畸形手术顺序选择的初步经验.中华骨科杂志, 1995, 15(8): 483-486.
13. Tang WM, Chiu KY. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty, 2000, 15(1): 52-58.
14. 郑润龙, 黄迅悟.人工膝关节置换假体的选择.中国医疗设备, 2015, 30(10): 20-24.
15. Boussofara M, Hamdi M, Mtaallah MH, et al. Combined lumbar plexus and sciatic nerve block in hip arthroplasty with severe ankylosing spondylitis. Tunis Med, 2013, 91(3): 223-224.
16. Tang WM, Chiu KY, Kwan MF, et al. Sagittal pelvic mal-rotation and positioning of the acetabular component in total hip arthroplasty: Three-dimensional computer model analysis. J Orthop Res, 2007, 25(6): 766-771.
17. 童培建.复杂人工膝关节置换.北京:人民卫生出版社, 2011: 19-26.
18. Mitsuyasu H, Matsuda S, Miura H, et al. Flexion contracture persists if the contracture is more than 15° at 3 months after total knee arthroplasty. J Arthroplasty, 2011, 26(4): 639-643.
19. Chung HK, Choi CH, Choi YJ, et al. Total knee replacement in severe flexion contracture. J Korean Knee Soc, 1997, 32: 1039-1046.
20. 张亮, 徐辉, 郭晓忠, 等.人工全髋关节置换术治疗强直性脊柱炎的中期疗效.中国修复重建外科杂志, 2014, 28(1): 1-6.
21. Ravi B, Escott B, Shah PS, et al. A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum, 2012, 64(12): 3839-3849.
22. 宋凯, 张永刚, 付君, 等.脊柱矫形对强直性脊柱炎胸腰段后凸畸形患者髋关节相关活动能力及生活质量的影响.中国脊柱脊髓杂志, 2015, 25(10): 871-882.
23. 曾勇, 何睿, 李庆, 等.脊柱楔形截骨并人工全髋关节置换术治疗强直性脊柱炎后凸畸形并髋关节重度屈曲挛缩畸形.中国修复重建外科杂志, 2014, 28(8): 942-946.
24. Gehrke T, Kendoff D, Haasper C. The role of hinges in primary total knee replacement. Bone Joint J, 2014, 96-B(11 Supple A): 93-95.
25. Xu X, Shen B, Zhang A, et al. Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis. Patient Prefer Adherence, 2016, 10: 879-885.
26. Durmus D, Sarisoy G, Alayli G, et al. Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue. Compr Psychiatry, 2015, 62(10): 170-177.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF BILATERAL TOTAL HIP AND KNEE ARTHROPLASTY FOR SEVERE INFLAMMATORY ARTHROPATHIES

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