A comparative study of total knee arthroplasty outcome for stiff knee with or without sequential antirheumatic drug treatment

J Orthop Surg Res. 2021 Aug 21;16(1):521. doi: 10.1186/s13018-021-02662-5.


Background: The aim of this study was to evaluate the influence of antirheumatic drug treatment on knee function of stiff knee patients after total knee arthroplasty (TKA).

Methods: Twenty-seven patients (44 knees) of active RA (rheumatoid arthritis) or AS (ankylosing spondylitis) with stiff knees were included in this study. And they were divided into two groups according to continue antirheumatic drug treatment or not after TKA: the therapeutic group (16 patients, 27 knees) and the controlled group (11 patients, 17 knees). The outcomes were assessed by Knee Society Score (KSS), Visual Analogue Scale (VAS), range of motion (ROM) (at week 6, month 6, year 1, and year 2), "Forgotten Joint" Scale (FJS), with or without crutch, satisfaction, and revision (at year 2). The knee prosthetic loosening was evaluated by the followed X-ray at each following time.

Results: The mean follow-up time was 51 months (34-69 months). The KSS was higher at week 6 after TKA in the therapeutic group (p < 0.05); however, the functional scores of KSS at month 6, year 1, and year 2 in the controlled group were more points improved. The therapeutic patients preferred the knee more at month 6, year 1, and year 2. The differences of KSS clinical scores (at month 6, year 1, and year 2), VAS, ROM, Crutch and FJS between the two groups were not statistically significant (p > 0.05).

Conclusion: For patients with stiff knees, the sequential antirheumatic drug treatment after TKA had no obvious effect on postoperative KSS, but can improve the satisfaction.

Level of evidence: Therapeutic level II. See Instructions for Authors for a complete description of levels of evidence.

Keywords: Ankylosing spondylitis; Rheumatoid arthritis; Sequential antirheumatic drug treatment; Stiff knee; Total knee arthroplasty.

MeSH terms

  • Antirheumatic Agents* / therapeutic use
  • Arthritis, Rheumatoid* / drug therapy
  • Arthritis, Rheumatoid* / surgery
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery
  • Knee Prosthesis* / adverse effects
  • Osteoarthritis, Knee* / diagnostic imaging
  • Osteoarthritis, Knee* / drug therapy
  • Osteoarthritis, Knee* / surgery
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome


  • Antirheumatic Agents