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Orthopaedics
Concurrent replacement of four major joints in a woman with advanced rheumatoid arthritis
  1. Sujit K Tripathy1,
  2. Mantu Jain1,
  3. Paulson Varghese2 and
  4. Sritam Jena2
  1. 1Orthopedics, AIIMS Bhubaneswar, Bhubaneswar, Orissa, India
  2. 2Anaesthesia, AIIMS Bhubaneswar, Bhubaneswar, Orissa, India
  1. Correspondence to Dr Mantu Jain; montu_jn{at}yahoo.com

Abstract

We report a case of a woman in her mid-40s with advanced rheumatoid arthritis (RA), with bilateral hip and knee joint involvement, who underwent a one-stage quadruple joint arthroplasty during a single session of anaesthesia. Chronic RA had severely incapacitated her, necessitating this uncommon surgical intervention. The surgical approach involved sequential bilateral total hip and knee replacements, which were completed within 180 min with a cumulative blood loss of 950 mL. The patient showed significant improvement with rapid mobilisation and regained joint function postoperatively. At 8 months post-surgery, the patient resumed her daily activities, showcasing the potential benefits and positive outcomes of quadruple joint arthroplasty in selected RA patients. This case, only the second documented globally, highlights the complexities and possibilities surrounding a single-stage quadruple joint arthroplasty in advanced RA.

  • Plastic and reconstructive surgery
  • Orthopaedic and trauma surgery

https://doi.org/10.1136/bcr-2023-258214

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    Footnotes

    • Contributors SKT, MJ, PV were the operating surgeons and SJ was the anaesthetist. Drafting of the text: PV, MJ, SKT. Sourcing and editing of clinical images: MJ. Investigation results and follow up: PV, SJ. Drawing original diagrams and algorithms: PV, SJ. Critical revision for important intellectual content: SKT, MJ, PV, SJ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.