A 60-year-old woman with severe end-stage rheumatoid arthritis of the knee (Larsen Grade V) continues to have pain and instability despite maximum medical therapy including biologic DMARDs. The most appropriate surgical option is:
- A Arthroscopic synovectomy to reduce inflammatory burden
- B Total knee replacement (TKR) with constrained or semi-constrained implant to address ligamentous laxity ✓
- C High tibial osteotomy to unload the medial compartment
- D Unicompartmental knee replacement
Correct answer: B. Total knee replacement (TKR) with constrained or semi-constrained implant to address ligamentous laxity
Explanation
Larsen Grade V represents complete joint destruction with mutilating deformity; this requires total joint replacement. RA knees frequently have significant ligamentous laxity and deformity, necessitating constrained or semi-constrained (posterior-stabilised or CCK) implants rather than cruciate-retaining designs. Synovectomy is palliative and appropriate only in early stages. HTO and unicompartmental replacement are contraindicated in pan-compartmental RA disease.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.