The Insall Award. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Problems and complications.

A series of patients with rheumatoid arthritis underwent total knee replacement with posterior cruciate ligament retention and was observed a minimum of 6 years and a mean of 8.2 years. A group of patients with osteoarthritis with an identical prosthesis and a group of patients with rheumatoid arthritis with a posterior stabilized implant served as controls. In the rheumatoid arthritis group with posterior cruciate ligament retention, there was an increased incidence in posterior instability and recurvatum deformity, resulting in an increased revision rate. Those patients undergoing revision for instability had a higher incidence of recurrent synovitis, and at revision the posterior cruciate ligament was grossly absent with a Grade 1 synovial reaction. In patients with rheumatoid arthritis undergoing total knee replacement, a posterior stabilized prosthesis rather than a posterior cruciate ligament sparing prosthesis should be used.