The basis of the current work is the analysis of the results of diagnostics and
treatment patients with rheumatoid arthritis, who underwent total knee arthroplasty for
axial deformities of knee joints. The surgeries were performed from 2013 to 2019 in the
Department of Joint Diseases in the Adult Institute of Traumatology and Orthopedics of
the National Academy of Medical Sciences of Ukraine. During this time 69 total knee
arthroplasties were performed in 60 patients with rheumatoid arthritis, among them 58
patients had axial deformities. In particular, 9 patients underwent total knee arthroplasty,
performed on both sides. These operations were performed at a late stage of the disease
(II stage IIIII
phase and stage III classification ET Sklyarenko, VI Stetsula, which
corresponds to stage IV rheumatoid arthritis according to the Steinbroker classification).
With the II stage of the disease there were 58 and with III 2
patients. In particular,
women were 53, men 5.
The age of patients ranged from 20 to 75 years and averaged
45,1 ± 12,1 years. Synovectomy of the knee joints was observed in 5 patients, of whom
1 patient had both knee synovectomy. The time elapsed from synovectomy to total knee
athroplasty varying from two to 8 years. Nine patients underwent hip replacement, and
6 patients underwent both hip replacement. In the clinic, patients underwent clinical,
laboratory and radiological examinations. Orthopedic status reflects, the presence of
contractures and the violation of the axis of the extremities.
Thus, in the examination of patients, we found violations of the limb axis in 58
(96,67%) cases, and in 2 (3,33%) cases without its violation. All patients with limb axis
disorders were divided into two groups. Valgus deformity of the shin was detected in 45
(77,59%) cases (from 10 to 15° in 35, from 16 to 20° in 7, more than 20° 3
cases). Varus
deformity of the limb axis was detected in 13 cases, (22,41%) (from 10 to 15° in 10, from
16 to 20° in 2 and more than 20° in 1case). Also, examination of patients revealed the
presence of a flexion contracture in 48 patients. Ankylosis in the knee joints were present
in 2 patients, in one of them both
knee joints.
In the course of our work we have studied and analyzed, according to radiographs and
computed tomography (CT), variants of anatomic and functional features of the
metaepiphyses of the bones, which form the knee joint during valgus or varus deformity.
We perform mathematical modeling of frontal deformities in the knee joint in RA. We
studied the osteogenic activity of stem stromal cells in the joint ends and the patella of
the knee joints with axial deformations, and we established correlation dependence with
the data of immunological and histomorphometric parameters. We perform discrete
determination of histomorphometric parameters of spongiosis of lateral and medial
femoral and tibial bone condyles, removed during knee replacement in patients with RA
and axial deformities. The technique of knee joint replacement in patients with RA and
frontal deformities has been improved. The program of physical rehabilitation of such
patients after endoprosthesis at the inpatient stage of rehabilitation was developed and its
effectiveness was determined.
