Journal List > J Korean Orthop Assoc > v.13(2) > 1124317

Lee: Management of bed-ridden patients with rheumatoid arthritis: Some recent cases


Management of bed-ridden patients with polyarticular rheumatoid arthritis poses a considerable challenge to the orthopedic surgeon. Five such illustrative cases are presented. Case 1, a 46 year old woman, previously had Knowles pinning and fibular graft done for a neck fracture of the right hip with avascular necrosis. With a new subcapital fracture and pinns, total hip arthroplasty was done. Due to osteoporosis and anatomical distorsion surgery, the stem of the prosthesis protruded through the femoral shaft. At two year follow-up, although confined to house, the stem was unloosened and she was free of pain, while she had developed painful avascular necrosis on the opposite side. Case 2, a 49 year old woman, had had bilateral total hip arthroplasty, one with and the other without trochanteric osteotomy, for avascular necrosis. She was free of symptoms except for pain due to trochanteric nonunion. After two years, re-wiring solved the problem. Case 3, a 48 year old female,had had multiple joint pain for 17 years, including the crippling both knees with flexion deformity of 90 and 50 degrees. Bilateral total knee arthroplasty was done with subsidence of pain and gain in motion. Case 4, a 52 year old woman, had multiple joint pain and stiffness for 13 years, being bed-ridden for the last two years. A case of classical rheumatoid arthritis, she had flexion contracture of both knees of 90 snd 95 degrees and an equinus deformity of the right ankle. Her hands and wrists were stiff and elbows and shoulders were also involved. Posterior capsulotomy was followed by bilateral total knee arthroplasty and a total ankle on the right. Postoperative course was complicated by delayed wound healing and subluxation. She was made ambulatory with a walker with Lofstrand crutches and a whole body suspension. Case 5, a 14 year old girl with classical juvenile rheumatoid arthritis, was bed-ridden since the age of seven. She had flexion deformity of both knees of 130/110 and also af both hips. Ankles, wrists, elbows and shoulders were also involved. On each knee, posterior capsulotomy and synovectomy, bone shortening and supracondylarosteotomy and hamstring transfer were done, followed by grsdusl extension by skeletal traction and cast wedging. The hospital course was prolonged because of peroneal palsy and pressure sore of tbe heel on the left and skin necrosis of the lateral wound of the right knee. Hwoever, the child went home ambulating with a bilateral long leg brace and crutches with a Lof-strand platform on the right.

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