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When is knee replacement surgery for RA recommended?

Howard J. Luks, MD
Sports Medicine

The indications for a knee replacement in patients with rheumatoid arthritis are not very different than the indications for a knee replacement in patients with osteoarthritis.  The main indication for a knee replacement is pain.  As orthopedists, we strive not necessarily to treat an MRI or an x-ray finding --- we strive to treat a patient.  Therefore, we need to have a very clear understanding of the degree of discomfort that you are having, the treatment alternatives that you have already tried, and most importantly, the affect that the pain is having on your quality of life.  If a patient with rheumatoid arthritis has severe, incapacitating knee pain that significantly interferes with their quality of life then they are most likely an appropriate candidate to consider a total knee replacement.  If other treatment alternatives are not controlling your pain well, then it may not be time to consider a knee replacement.  Those patients who are considering knee replacements should be well-versed in the concept of shared decision making.  This is a process where you, and your surgeon sit down and have a long discussion about how your disease is affecting your life and whether or not you feel that the pain that you are having is significant enough to warrant a big procedure such as a total knee replacement.

 

That said, there are certain circumstances where a knee replacement should be done sooner rather than later.  These are in cases of profound knock knee deformities.  If these deformities become too severe.  Then there is a significant risk of nerve damage when the knee is replaced.  I mention this only because not knee deformities of the classic deformity seen in some patients with rheumatoid arthritis.  This is very different than your counterparts with osteoarthritis who tend to develop bowed legs.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.