A 55-year-old woman with severe end-stage rheumatoid arthritis of both knees affecting activities of daily living, despite maximal medical therapy, is referred for surgical management. The procedure of choice is:
- A High tibial osteotomy (HTO)
- B Unicompartmental knee replacement (UKR)
- C Total knee replacement (TKR) ✓
- D Arthroscopic synovectomy
Explanation
Total knee replacement (TKR) is the definitive surgical treatment for end-stage rheumatoid arthritis of the knee when medical therapy fails. RA involves all three compartments and the synovium diffusely, precluding unicompartmental replacement. HTO is indicated for unicompartmental OA in younger patients with varus deformity and intact ligaments — not in RA with multi-compartment disease. Arthroscopic synovectomy may provide temporary benefit in early RA synovitis but does not address end-stage joint destruction. TKR achieves reliable pain relief and functional improvement in RA, though component longevity may be slightly reduced compared to OA due to osteopenic bone.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.