A 52-year-old woman with long-standing seropositive RA presents with severe valgus knee deformity (25°) and severe tricompartmental destruction on radiograph. She has failed medical management. She has marked quadriceps weakness (Grade 3/5) and significant osteoporosis (T-score −3.2). Which additional surgical planning consideration is MOST important for her TKR?
- A Use of a constrained condylar prosthesis due to ligamentous laxity
- B Prophylactic tibial plateau bone grafting for cystic defects
- C Preoperative cervical spine assessment for atlantoaxial instability ✓
- D Staged bilateral simultaneous TKR to reduce total anesthetic exposure
Explanation
Patients with long-standing RA have a significant incidence (17–86%) of cervical spine involvement, particularly atlantoaxial (C1–C2) instability due to erosion of the transverse ligament and odontoid process. Unsuspected atlantoaxial instability poses a risk of spinal cord injury during general anesthesia (intubation, neck positioning). Therefore, preoperative lateral cervical flexion-extension radiographs are mandatory before any elective surgery requiring general anesthesia in RA patients. While constrained implants and bone grafting are valid technical considerations, cervical assessment is the most critical SAFETY planning step.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.