Objective: To assess the outcome of minimum 10 year followup of total joint arthroplasty (TJA) in nonambulatory patients with rheumatoid arthritis (RA).
Methods: TJA was performed in 40 nonambulatory patients with RA who satisfied the following criteria: (1) strong motivation; (2) good relationship with our medical staff; (3) no marked cervical cord lesion: (4) absence of severe systemic complications. These included 38 women and 2 men whose average age at the initiation of TJA was 58.8 years. The duration of time between loss of walking ability and surgery was 2 months to 5 years. Average hospitalization time was 4.5 months. Followup after the last surgery was 10 to 18 years.
Results: One year after the last surgery, 28 of the 40 patients could walk outdoors again, 11 indoors, and one was still unable to walk. By 5 years after surgery, 9 patients had died of diseases unrelated to surgery. Of the remaining 31 patients, 19 could walk outdoors, 10 indoors, and 2 could not walk. Deterioration of walking was observed in 13 patients (41.9%) compared with one year after surgery. By 10 years after surgery, 32 patients had died of diseases unrelated to surgery, 4 could walk outdoors, 4 indoors. Of these, 4 patients (50%) had worsened in walking ability compared with one or 5 years after surgery. Major complications of TJA were observed in 12 patients. These were femoral neck fractures in 3, supracondylar femoral fractures in 3, loosening of the acetabulum socket in 4, loosening of the femoral hip prosthesis in 2.
Conclusion: TJA should be a useful treatment for restoration of walking in nonambulatory patients with RA. However, even after TJA, walking ability deteriorated in about half of the patients as the duration of followup observations exceeded 5 years.