We studied 11 patients (14 elbows) with gross rheumatoid deformity of the elbow, treated by total arthroplasty using the Kudo type-5 unlinked prosthesis, and who were evaluated between five and 11 years after operation. Massive bone defects were augmented by autogenous bone grafts. There were no major complications such as infection, subluxation or loosening. In most elbows relief from pain and stability were achieved. The results, according to the Mayo Elbow Performance Score, were excellent in eight, good in five and fair in one. In most elbows there was minimal or no resorption of the grafted bone. There were no radiolucent lines around the stems of the cementless components. This study shows that even highly unstable rheumatoid elbows can be replaced successfully using an unlinked prosthesis, with augmentation by grafting for major defects of bone.

Objective: The aim of this study was to evaluate the safety and efficacy of sequential bilateral total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA), in comparison with staged bilateral and unilateral TKA.

Patients and Methods: Between July 2000 and June 2005, 340 TKA were performed in our department. We investigated retrospectively the clinical data of each patient, including the peri-operative data such as the surgical time, the amount of haemorrhage and postoperative adverse events. We also examined the clinical outcome before and after bilateral TKA by using the Japanese Orthopaedic Association (JOA) evaluation chart of knee joint function (JOA score).

Results: We have done sequential bilateral TKA for 60 knees of 30 patients (group A), staged bilateral TKA for 26 knees of 13 patients (group B) and unilateral TKA for 254 knees (group C). Before TKA, the mean JOA score were 44.9, 40.1, 46.4 points, and the mean range of motion of affected knees were 14.6–113.6°, 27.9–89.6°, 14.1–116.9° in group A, B and C, respectively, indicating that group B included more severe cases. Whereas the mean surgical time were 136.4, 158.4, 154.3 minutes, the mean amount of peri-operative haemorrhage were 414.6, 273.4, 277.7 ml in group A, B and C, respectively. Although we experienced 1 case with symptomatic pulmonary embolism in group A, which was successfully treated, there was none of cases with death within 1 month of surgery or early-phase infection. The JOA score at final follow-up (the mean follow-up period was 1 year and 8 months) were 91.1 and 86.9 points in group A and B, respectively, showing good results in both groups.

Conclusion: In short-term data, sequential bilateral TKA was successfully performed and beneficial approach to patients with RA. The intensive pre- and post-operative management could be essential for good clinical outcome. Further improvement should be needed to perform this procedure more safely and prevent complications, especially serious cardiopulmonary events.