A 55-year-old woman with long-standing rheumatoid arthritis (RA) presents with bilateral knee pain, valgus deformity, and destroyed joint surfaces on X-ray. She failed DMARDs and biologics. Which surgical intervention has the most durable outcomes for end-stage RA knee disease?
- A Synovectomy alone (arthroscopic or open)
- B High tibial osteotomy to correct the valgus deformity
- C Total knee replacement (TKR) with constrained or semi-constrained implant to address ligamentous laxity ✓
- D Knee arthrodesis as the first-line surgical treatment
Explanation
End-stage RA with destroyed joint surfaces and valgus deformity is a clear indication for TKR. RA patients often have ligamentous laxity and soft tissue imbalance due to chronic synovitis, requiring constrained or semi-constrained (e.g., posterior-stabilized with varus-valgus constraint) implants that provide coronal plane stability. TKR in RA provides excellent pain relief and function restoration. Synovectomy is only useful in early disease with synovitis but intact cartilage. High tibial osteotomy is inappropriate in end-stage tricompartmental destruction. Arthrodesis is a salvage procedure for failed TKR or severe infection, not first-line.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.