scholarly journals Thermal imaging in total knee replacement and its relation with inflammation markers

2021 ◽  
Vol 18 (6) ◽  
pp. 7759-7773
Author(s):  
Viney Lohchab ◽  
◽  
Jaspreet Singh ◽  
Prasant Mahapatra ◽  
Vikas Bachhal ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Skin Temperature ◽  
Knee Replacement ◽  
Thermal Imaging ◽  
Inflammatory Markers ◽  
Mean Skin Temperature ◽  
Inflammation Markers ◽  
Relative Percentage ◽  
Total Knee ◽  
The Mean

<abstract> <p>Total knee replacement is an end-stage surgical treatment of osteoarthritis patients to improve their quality of life. The study presents a thermal imaging-based approach to assess the recovery of operated-knees. The study focuses on the potential of thermal imaging for total knee replacement and its relation with clinical inflammatory markers. A total of 20 patients with bilateral knee replacement were included for thermal imaging and serology, where data was acquired on pre-operative day and five post-operative days. To quantify the inflammation, the temperature-based parameters (like mean differential temperature, relative percentage of raised temperature) were evaluated from thermal images, while the clinically proven inflammation markers were obtained from blood samples for clinical validation. Initially, the knee region was segmented by applying the automatic method, subsequently, the mean skin temperature was calculated and investigated for a statistical relevant relationship with inflammatory markers. After surgery, the mean skin temperature was first increased (&gt;2.15 ℃ for different views) then settled to pre-operative level by 90th day. Consequently, the mean differential temperature showed a strong correlation with erythrocyte sedimentation rate (r &gt; 0.893) and C-reactive protein (r &gt; 0.955). Also, the visual profile and relative percentage of raised temperature showed promising results in quantifying the temperature changes both qualitatively and quantitatively. This study provides an automatic and non-invasive way of screening the patients for raised levels of skin temperature, which can be a sign of inflammation. Hence, the proposed temperature-based technique can help the clinicians for visual assessment of post-operative recovery of patients.</p> </abstract>

Kniegelenksendoprothetik bei hämophiler Arthropathie

2010 ◽  
Vol 30 (S 01) ◽  
pp. S104-S106
Author(s):  
W. Miesbach ◽  
L. M. Sahner ◽  
A. Kurth ◽  
B. Habermann
Keyword(s):  
Quality Of Life ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Society Score ◽  
Normal Population ◽  
Knee Function ◽  
Total Knee ◽  
The Mean

Summary Purpose Purpose of this retrospective study was to evaluate our own results after total knee replacement in patients with haemophilia. Patients, material, method: 30 patients with haemophilia who underwent total knee replacement between 1987 and 2005 were included. We used the clinical and radiological Knee Society Score. Furthermore, the Petterson and the Arnold and Hilgartner score were applied. Results: The mean age at the time of surgery was 43.2 (27–66). At the time of follow- up examination the mean age was 51.6 (30–82) years. The mean follow-up was 7.1 (2–20) years. Preoperative, he mean Arnold and Hilgartner score was 4.17 (± 0.59) and the mean Petterson-Score was 9 ± 2.29. Compared to the preoperative deficiency in knee function (KSS-Score 88.17 ± 33.58) an improvement with 166.67 (± 22.73) points was seen. 1 patient showed an aseptic loosening after 11 years. Discussion: Total knee replacement in patients with haemophilia improves knee function and quality of life. The results of our study represent results in earlier published studies. Compared to a non-haemo-philic normal population the rate of perioper-ative complications was not increased.

scholarly journals Computed tomography is not necessary to assess rotation of the femoral component in navigation-assisted total knee replacement

2016 ◽  
Vol 44 (6) ◽  
pp. 1314-1322 ◽  
Author(s):  
Daniel Hernández-Vaquero ◽  
Alfonso Noriega-Fernandez ◽  
Ivan Perez-Coto ◽  
Manuel A. Sandoval García ◽  
Andres A. Sierra-Pereira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Transepicondylar Axis ◽  
Component Rotation ◽  
Preoperative Ct ◽  
Total Knee ◽  
The Mean ◽  
Ct Data

Objective To demonstrate that postoperative computed tomography (CT) is not needed if navigation is used to determine the rotational position of the femoral component during total knee replacement (TKR). Methods Preoperative CT, navigational, and postoperative CT data of 70 TKR procedures were analysed. The correlation between the rotational angulation of the femur measured by CT and that measured by perioperative navigation was examined. The correlation between the femoral component rotation determined by navigation and that determined by CT was also assessed. Results The mean femoral rotation determined by navigation was 2.64° ± 4.34°, while that shown by CT was 6.43° ± 1.65°. Postoperative rotation of the femoral component shown by CT was 3.09° ± 2.71°, which was closely correlated with the angle obtained through the intraoperative transepicondylar axis by navigation (Pearson’s R = 0.930). Conclusions Navigation can be used to collect the preoperative, intraoperative, and postoperative data and final position of the TKR. The rotation of the femoral component can be determined using navigation without the need for CT.

scholarly journals Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements

2021 ◽  
Author(s):  
H Sivasubramanian ◽  
CMP Tan ◽  
L Wang
Keyword(s):  
Pain Relief ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Functional Outcomes ◽  
Primary Total Knee Replacement ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

Introduction: The use of peri-articular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) tranexamic acid has not been well explored in literature. This retrospective cohort study aims to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate post-operative pain relief and functional outcomes in unilateral primary total knee replacement (TKA) patients. Methods: 63 patients who underwent a unilateral primary total knee replacement procedure were divided into 2 groups: 42 patients in the IA TXA delivery group, 21 patients in the PA TXA group. 1g of TXA was utilized for all patients. All patients had pericapsular infiltration consisting of 0.5ml of Adrenaline, 0.4ml of Morphine, 1g of Vancomycin, 1ml of Ketorolac and 15ml of Ropivacaine. Outcomes for blood loss, and surrogate markers for immediate functional recovery were measured. Results: 54.0% of the patients were female, 46.0% male. The mean drop in post-operative Hb levels in the PA and IA group was 2.0g/dL and 1.6 g/dL respectively, and statistically insignificant (p=0.10). The mean HCT drop in the PA and IA group was 6.1% and 5.3% respectively and statistically insignificant (p=0.58). The POD 1 and discharge day flexion angles, POD 1 and POD 2 VAS scores, gait distance on discharge, and length of hospitalization stay were largely similar in both groups. Conclusion: Our study shows that both IA and PA TXA with analgesic components are equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

scholarly journals Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement

2016 ◽  
Vol 50 (2) ◽  
pp. 64-68
Author(s):  
Arunkumar Vijay ◽  
Jambu Nageswaran ◽  
Senthil Loganathan ◽  
Samuel Chittaranjan Bedford
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Primary Total Knee Replacement ◽  
Group A ◽  
Total Knee ◽  
The Mean ◽  
Group B ◽  
Primary Total Knee

ABSTRACT Aim To study the efficacy of topical intraarticular vs intravenous tranexamic acid (TXA) in reducing blood loss following primary total knee replacement (TKR). Materials and methods A phase 3, single center, double blind and randomized controlled study was conducted in the Department of Orthopedics, Sri Ramachandra University, Chennai, Tamil Nadu. A prospective study of 100 patients lasted from July 2013 to July 2015. Results Postoperative transfusion rates were zero in both the groups (intraarticular and intravenous). The mean 48-hour drain collected is 285.6 ml in group A (intraarticular), while it is 325.8 ml in group B (intravenous); the mean drop in hemoglobin is 1.7 gm/dl in group A (intraarticular) while it is 2.4 gm/dl in group B (intravenous). Conclusion This study shows that topical intraarticular administration of TXA has better efficacy than intravenous TXA in controlling postoperative blood loss following primary uncomplicated TKR with no significant complications. How to cite this article Vijay A, Nageswaran J, Loganathan S, Bedford SC. Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement. J Postgrad Med Edu Res 2016;50(2):64-68.

scholarly journals Timing of Re-Transfusion Drain Removal Following Total Knee Replacement

2006 ◽  
Vol 88 (2) ◽  
pp. 134-135 ◽  
Author(s):  
MF Leeman ◽  
ML Costa ◽  
E Costello ◽  
D Edwards
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Medical Records ◽  
Optimal Time ◽  
Drain Removal ◽  
Postoperative Drainage ◽  
Total Knee ◽  
The Mean

INTRODUCTION The use of postoperative drains following total knee replacement (TKR) has recently been modified by the use of re-transfusion drains. The aim of our study was to investigate the optimal time for removal of re-transfusion drains following TKR. PATIENTS AND METHODS The medical records of 66 patients who had a TKR performed between October 2003 and October 2004 were reviewed; blood drained before 6 h and the total volume of blood drained was recorded. RESULTS A total of 56 patients had complete records of postoperative drainage. The mean volume of blood collected in the drain in the first 6 h was 442 ml. The mean total volume of blood in the drain was 595 ml. Therefore, of the blood drained, 78% was available for transfusion. CONCLUSION Re-transfusion drains should be removed after 6 h, when no further re-transfusion is permissible.

scholarly journals THE EFFECT OF TRANEXAMIC ACID INJECTION ON HEMOGLOBIN LEVEL, ALBUMIN LEVEL, AND PAIN ON PATIENT RECEIVING TOTAL KNEE REPLACEMENT

2019 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Dwikora Novembri Utomo ◽  
Teddy Heri Wardhana ◽  
Ahmad Hannan Amrullah ◽  
Hamzah Hamzah
Keyword(s):  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Blood Transfusions ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee Replacement Surgery ◽  
Vas Scores ◽  
Total Knee ◽  
The Mean

Background: The high number of knee osteoarthritis cases could lead arthroplasty more frequent. Total Knee Replacement (TKR) surgery procedure is at risk of massive bleeding. Bleeding can affect albumin levels and the onset of intra-compartment pressure on the nerves. The use of tranexamic acid could be done to reduce bleeding.Objective: Proving the effect of intravenous tranexamic acid administration on patients who will undergo TKR surgery.Methods: The experiment was conducted experimentally using primary laboratory data obtained before and after surgery in patient which will be performed TKR operation starting from April 2017.Result: There are 64 patients who had undergone total knee replacement surgery. The mean preoperative hemoglobin in the tranexamic acid group and without tranexamic acid was 13.06±1.46g/dl and 12.44±0.87g/dl. The mean hemoglobin after surgery was 10.29 ±1.14 g/dl and 9.16±0.97 g/dl. In the group receiving tranexamic acid, 32 (100%) reported low postoperative VAS scores, did not require blood transfusions and did not require albumin transfusion. Groups not receiving tranexamic acid, 32 (100%) moderate postoperative VAS scores, 4 people (12.5%) required the blood transfusion, and 3 (9.4%) required transfusion of albumin.Conclusion: The results of this study showed that the group given tranexamic acid had higher hemoglobin levels after surgery than the untreated group of tranexamic acid; there was no difference in albumin levels after surgery in both groups; the administration of tranexamic acid will decrease the amount of blood loss, decrease the degree of pain, and decrease the need for blood transfusions after total knee replacement surgery.

Wound closure after total knee replacement: Comparison between staples and sutures

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Mansoor Ali Khan ◽  
M. Waseem Memon ◽  
Amin Chinoy ◽  
Salman Javed ◽  
Rahil Barkat ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Wound Closure ◽  
P Value ◽  
Incision Length ◽  
Total Knee ◽  
The Mean ◽  
The Right

Background and Objective: Total Knee Arthroplasty is a commonly performed procedure for arthritic knees. Preventing complications is of utmost importance for good functional outcomes and preventing morbidity. Wound closure after the procedure is as important as the replacement aspect of surgery.The objective of this study was to provide subjective and objective evidence of better closure technique and material; we conducted the study so that the outcome of TKA can be further improved. Methods: We conducted a randomized trial at The Indus Hospital, Karachi, from December 2018 to June 2020. All patients from age 40 to 70 years who underwent total knee arthroplasty were included in the study. The wound of one knee was closed with Polypropylene (Prolene) sutures, and the other with staples. The wound was assessed independently by two assessors using Hollander’s score; lower score means a worse outcome. All data was entered and analyzed using STATA version 16. Results: Thirty patients who underwent bilateral total knee replacement were included in the analysis, among which 71.8% were female. The average age of participants was 57.3 (± 7.5) years. The mean incision length on the right knee was 17.6 ± 1.1 cm, while on the left the incision length was 18.3 ± 1.2 cm. Overall, the mean Hollander score was significantly different among participants in the sutures and staples group in both the right (p-value=0.001) and left knees (p-value=0.001). The score was significantly higher in knees closed with sutures as compared to staples. Also, the mean Hollander score is significantly higher in females than males in both the right knee (B=0.56, p-value=0.049) and the left knee (B=0.38, p-value=0.044). Conclusion: The study has shown that Hollander’s score was significantly higher in knees closed with sutures as compared to the patients in whom staples were used for wound closure. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5782 How to cite this:Khan MA, Memon MW, Chinoy A, Javed S, Barkat R, Jiwani A. Wound closure after total knee replacement: Comparison between staples and sutures. Pak J Med Sci. 2022;38(2):340-344. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5782 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Preoperative Hemoglobin Levels, Characteristics, and Resource Utilization in Total Knee Replacement Patients with An Anemia Diagnosis Versus without An Anemia Diagnosis: An Electronic Medical Record Analysis

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2089-2089
Author(s):  
Jamie B. Forlenza ◽  
Lorie Ellis ◽  
Helene Parise ◽  
Marie-Hélène Lafeuille ◽  
Patrick Lefebvre
Keyword(s):  
Total Knee Replacement ◽  
Resource Utilization ◽  
Knee Replacement ◽  
Total Population ◽  
Categorical Variables ◽  
Total Study Population ◽  
Preoperative Hemoglobin ◽  
Comorbidity Burden ◽  
Total Knee ◽  
The Mean

Abstract Abstract 2089 Purpose: This retrospective analysis describes preoperative hemoglobin (Hb) levels, characteristics, and resource use in total knee replacement (TKR) patients who had an anemia diagnosis as compared to those without an anemia diagnosis. Methods: Electronic medical records (EMR) from a large US integrated health delivery system were analyzed for the period 01/2004 to 09/2010. Adult patients with a TKR surgery record and ≥1 Hb measurement were studied. Patients with a hip or knee revision before or during surgery, with bilateral surgery, or with an emergency room (ER) visit on the surgery admission date were excluded. Patients were stratified into two groups based upon the presence or absence of an anemia diagnosis (ICD-9 codes 280.xx-285.xx) in the 90 days before or day of surgery. Hemoglobin levels measured in the 45 days prior to but excluding the day of surgery were analyzed. For patients with multiple Hb measurements, the earliest observed Hb measurement (defined as the measurement collected furthest in time from the date of surgery) was evaluated. Other clinical and demographic characteristics in the 90 days before or day of surgery and resource utilization in the 90 days pre-surgery were analyzed. Descriptive statistics were reported as frequencies and means±standard deviations, and groups were compared using the Pearson chi-square test for categorical variables and Student's t-test for continuous variables. Results: The total study population consisted of 2,984 TKR patients, of which, 9.1% (n=273) had an anemia diagnosis. In patients with an anemia diagnosis, the first anemia diagnosis in the EMR occurred 38±30 days before surgery. Patients with an anemia diagnosis versus those without an anemia diagnosis tended to be older (mean age 70.3±10.2 vs 67.5±10.0 years, respectively; p<0.001), have a lower proportion that were white (95.2% vs 98.5%, respectively; p<0.001), and have a higher comorbidity burden as measured by the Quan-Charlson Comorbidity Index (Q-CCI) (mean Q-CCI of 1.2±1.3 vs 0.6±1.0, respectively, p<0.001). The mean earliest Hb level for the total population was 13.7±1.3 g/dL and was <13 g/dL in 28.2% of TKR patients and <12 g/dL in 9.6% of TKR patients. The mean earliest Hb level was 12.5±1.3 g/dL in patients with an anemia diagnosis and was 13.8±1.2 g/dL for the group without an anemia diagnosis (p<0.001). Of patients with an anemia diagnosis, the majority (62.3%) had an earliest Hb level <13 g/dL (versus 24.8% of those without an anemia diagnosis; p<0.001) while 33.7% of those with an anemia diagnosis had an earliest Hb level <12 g/dL (versus 7.1% of those without an anemia diagnosis; p<0.001). Seven percent of patients with an anemia diagnosis had a hospitalization in the 90 days before TKR surgery versus 3.0% of those without an anemia diagnosis (p<0.001). In addition, 5.9% of the group with an anemia diagnosis had an ER visit versus 2.8% of those without an anemia diagnosis (p=0.005). In the 90 days pre-TKR surgery, the anemia diagnosis group had 5.0±2.7 days with an office/outpatient visit and 11.9±6.0 days with another-type service (e.g., prescription refill, administrative services) while the group without an anemia diagnosis had 3.6±2.0 (p<0.001) and 7.4±4.4 (p<0.001) days with these respective services. Conclusions: In this EMR database analysis, more than 9% of patients had an anemia diagnosis based upon ICD-9 codes in 90 days before or day of TKR surgery. Patients with an anemia diagnosis differed from those without an anemia diagnosis for certain characteristics including age, proportion who were white, comorbidity burden, and mean earliest Hb levels. The proportion of patients with a hospitalization in the 90 days preceding TKR surgery was significantly greater in patients with an anemia diagnosis as compared to those without an anemia diagnosis. In the total population, over 28% and 9% of patients had an earliest Hb value <13 g/dL and <12 g/dL, respectively, however, in patients without an anemia diagnosis, over 24% and 7% had an earliest Hb level <13 g/dL and <12 g/dL, respectively. This research provides further insight into preoperative Hb levels for a population of TKR patients with and without anemia diagnosis codes. Further research is warranted to better understand these variations between groups as well as the implications of these differences on preoperative management and post-operative outcomes in TKR populations. Disclosures: Forlenza: Janssen Scientific Affairs, LLC: Employment. Ellis:Janssen Scientific Affairs, LLC: Employment. Parise:Janssen Scientific Affairs, LLC: Consultancy. Lafeuille:Janssen Scientific Affairs, LLC: Consultancy. Lefebvre:Janssen Scientific Affairs, LLC: Consultancy.

scholarly journals A Selective arthroplasty algorithm contributes to clinical outcome and patient satisfaction in patients with osteoarthritis of the knee

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0032
Author(s):  
Johannes Holz ◽  
Stefan Schneider ◽  
Nils Hansen-Algenstaedt ◽  
Rene Kaiser ◽  
Ansgar Ilg
Keyword(s):  
Patient Satisfaction ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Patient Reported Outcomes ◽  
Oxford Knee Score ◽  
Consecutive Series ◽  
Single Center ◽  
Patient Reported ◽  
Total Knee ◽  
The Mean

Aims and Objectives: The purpose was to evaluate the clinical outcomes and patient satisfaction of patients with knee osteoarthritis treated within a selective arthroplasty algorithm, using focal metal implants (FMI), unicompartmental (UKA), patellofemoral (PFA), bicompartimental (BKA) and total knee arthroplasty (TKA) in a single center. Materials and Methods: This is a prospective study analyzing a consecutive series of 613 patients treated by two surgeons in a single center. In 283 men and 330 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. 357 UKA, 178 TKA, 30 PFA, 23 BKA and 25 FMI were performed. Implants were cemented or cementless (UKA) and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS) and Knee Society Score (KSS Expectations and satisfaction)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 442 of 457 eligible patients (Compliance = 96,7%) have thus far completed the 12 months follow-up time point. Results: All mean KOOS, OKS, KSS and VAS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49.8±13,3 to 74,8±16.9 in UKA, from 43,9±13,3 to 65,2±12,4 in PFA, from 46.6±13,1 to 73,8±14,4 in TKA, from 45,2±11,2 to 73,0±9,8 in BKA and 40.9 ± 23.0 to 63.2 in FMI (p<0.05). Mean preoperative aggregated OKS improved from 25,3±7,6 to 38,7±8,4 in UKA, from 22,9±7,6 to 33,3±8,6 in PFA, from 23.3±7.3 to 37,5±7.7 in TKA, from 22,0±7,5 to 39,0±4.0 in BKA and from 22.9 ± 10.0 to 33.4 ± 11.3 in FMI (p<0.05). The mean pain level VAS decreased from pre-treatment to 12 months after surgery in UKA from 5.6 to 1.6, in PFA from 6.2 to 2.8, in TKA from 6.2 to 1.7, in BKA from 6.8 to 1.6 and VAS 5.5 to 2.4. The Mean KSS Expectation/Satisfaction improved at 1 y FU in UKA in expectation 13.7 ± 1.6 and mean KSS satisfaction: 31.1 ± 8.4, in FMI in expectation: 13.5 ± 1.6 and mean KSS satisfaction 26.0 ± 11.4 , in TKA: expectation 13.5 ± 1.8 and mean KSS satisfaction 30.0 ± 7.1, in PFA: expectation 13.7 ± 1.7 and mean KSS satisfaction 26.4 ± 9.2 and BKA: expectation 13.6 ± 1.9 and mean KSS satisfaction 31.2 ± 4.2. Two patients (0.4%) underwent revision (at 3 month for inlay dislocation (UKA) and at 12 Month for desease progression (FMI)). Conclusion: This study shows excellent clinical results and patient satisfaction of patients treated within a selective arthroplasty algorithm. Adherence to strict indications for partial as well as for total knee replacement will lead to a comparable significant improvement of patient reported outcomes, patient satisfaction and a low revision rate one year postoperatively.

Acute Total Knee Replacement in Rheumatoid Arthritis Patients with Proximal Tibial Fractures: A Case Series

2020 ◽  
Author(s):  
Fardin Mirzatolooei ◽  
Ali Tabrizi ◽  
Mir Bahram Safari ◽  
Seyed Amir Mahlisha Kazemi Shishavan
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Case Series ◽  
Normal Activity ◽  
Tibial Fractures ◽  
Proximal Tibial Fractures ◽  
Total Knee ◽  
The Mean ◽  
And Function

AbstractManagement of proximal tibial fractures is a challenging issue in patients with rheumatoid arthritis (RA). In the present study, we aimed to describe our experience of acute total knee replacement in RA patients.This case series included 11 RA patients with simultaneous insufficiency fractures of the proximal tibia, who were treated by acute total knee replacement. Midterm functional results, severity of pain, Hospital for Special Surgery (HSS), and Knee Society Score (KSS) parameters were evaluated in this study. The patients were followed up for 24 months.Eleven women with proximal tibial fractures and history of RA (mean age: 54.3 ± 4.7 years) were enrolled in this study. The mean score of Tegner activity scale was 2.2 ± 1.4 preoperatively, which significantly improved to 4.3 ± 1.4 postoperatively (p < 0.001). The two sections of KSS (knee and function section) averaged 88.7 ± 5.4 and 59.4 ± 8.2, respectively. There wasn't poor outcome and excellent result was in knee section 54.5% and function section 36.3% based on KSS. The mean score of pain severity during normal activity before fracture was 65.2 ± 12.3, which significantly reduced to 35.5 ± 11.3 in the final follow-up (p = 0.02). The score of HSS scale improved from 42 (range: 16–58) in the preoperative stage to 78 (range: 72–91) after surgery (p < 0.001). In the 6-month follow-up, deep vein thrombosis was reported in two patients. The time required to return to normal activity was 5.5 ± 2.3 months.Based on the findings, total knee replacement therapy in patients with RA and proximal tibial fractures produced excellent clinical outcomes, which led to rapid return to normal activity. This is a Level IV, therapeutic study.

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