Rheumatoid Arthritis: Is A Knee Replacement the Solution?
Knee replacements were once commonplace in cases of rheumatoid arthritis. So why is that no longer the case? Jim Newman explains.
Browse the knee replacement-related blog posts and pages of this site and I imagine the word ‘osteoarthritis’ (OA) will crop up on virtually every one. Of course, OA isn’t the only form of arthritis, yet you’ll find rheumatoid arthritis (RA) receives barely a mention.
Around 400,000 people in the UK live with RA and it can affect people of any age, so why is a knee replacement not as common in RA cases as OA? The answer is simply that the two forms of arthritis are very different, and where knee replacement was once a relatively common treatment for both (certainly when I was a trainee knee surgeon), improvements in treating RA have meant that replacements are used far more sparingly.
What’s the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis is typically described as ‘wear and tear’ of the knee, which gradually leads to the cartilage being worn away, leaving bone grinding against bone. We now know that the traditional wear and tear definition is a little simplistic – and I explain why in this post – but it’s very different to rheumatoid arthritis.
RA is an inflammatory condition. It is genetic and whilst we don’t know what the trigger is, most people have measurable factors in the blood that indicate whether someone is likely to get it.
The NRAS describes RA as an autoimmune response in which the body’s immune system mistakenly attacks the lining of the joints, causing pain and inflammation. It can also be an erosive condition, removing bone and creating an extremely challenging environment for knee replacement.
Happily, and unlike OA, RA is treatable with a range of painkillers, inhibitors and steroids which reduce pain, reduce inflammation and, crucially, reduce and control the way the immune system attacks the joints. These new, advanced medical therapies are so effective that knee replacement for RA is nowhere near as common as it once was.
RA and knee replacements
There remain some occasions when an RA sufferer will have a knee replacement. I still perform plenty of them each year in cases where the drugs are working well, but surgical intervention is also required. What’s interesting about these cases is that the RA-afflicted knee looks more like a case of OA, and it may be that these are cases of RA sufferers who have also developed OA.
Symptoms of arthritis and when to seek help
As you might expect, the symptoms of OA and RA share certain similarities. Both can result in joint pain and swelling (although swelling tends to be more pronounced in RA). Joints can feel stiff and inflexible, and that stiffness can be worse after periods of sleep or inactivity.
Rheumatoid arthritis can make you feel fatigued in a way that OA does not. It can progress relatively quickly, over weeks and months rather than years, and it can begin at any age. OA tends to occur later, although it too is certainly not confined purely to old age.
If you suspect the onset of arthritis, it’s important to have it diagnosed swiftly as that can dramatically affect the outcome and the success of any treatment, irrespective of the type of arthritis.
To talk to a knee specialist now, please contact us.