Osman Wael Samir, Younis Ahmed Saeed, Thompson Jacqueline, Amin Amr Amal, El-Sebai Mahmoud
Orthopaedic Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Arthroplast Today. 2020 Jul 13;6(3):487-491. doi: 10.1016/j.artd.2020.06.002. eCollection 2020 Sep.
Rheumatoid arthritis (RA) is a chronic systemic disease that causes progressive joint damage, bony defects, and ligament imbalance. These sequelae of RA present major difficulties to surgeons during hip or knee arthroplasty. The presence of coexistent periarticular fractures adds to these difficulties and represents a surgical dilemma. No guidance exists within the literature for the medical and surgical management of complicated cases of RA with coexistent fractures. So far, the evidence has focused on fixation techniques, arthroplasty, and conservative management for periarticular fractures of osteoarthritic joints without significant degeneration of anatomical structures. We report a case of advanced knee RA with associated ipsilateral tibial plateau fracture and a tibial shaft stress fracture that was treated successfully with a single-stage joint replacement procedure. The case study presents a well-planned, single-stage arthroplasty with a lateral parapatellar approach as a management option that allows for early weight-bearing and restoration of function and provides a detailed guide for surgeons when managing similar cases.
类风湿性关节炎（RA）是一种慢性全身性疾病，可导致进行性关节损伤、骨质缺损和韧带失衡。RA的这些后遗症给髋关节或膝关节置换术中的外科医生带来了重大困难。并存的关节周围骨折更是增加了这些困难，成为一个手术难题。文献中没有关于合并骨折的复杂RA病例的医疗和手术管理的指导。到目前为止，证据主要集中在骨关节炎关节周围骨折的固定技术、关节置换术和保守治疗上，而这些关节的解剖结构没有明显退变。我们报告了一例晚期膝关节RA合并同侧胫骨平台骨折和胫骨干应力骨折的病例，该病例通过单阶段关节置换手术成功治疗。该病例研究展示了一种精心规划的单阶段关节置换术，采用髌旁外侧入路作为一种管理选择，允许早期负重和功能恢复，并为外科医生处理类似病例提供了详细指导。
