SHORTENING FEMORAL OSTEOTOMY WITH STEMMED RESURFACING TOTAL KNEE ARTHROPLASTY FOR SEVERE FLEXION CONTRACTURE IN JUVENILE RHEUMATOID ARTHRITIS

Purpose: Juvenile Rheumatoid Arthritis (JRA) is a progressive disease characterized by pain, swelling, and loss of motion in the joints of adolescents. Total Knee arthroplasty (TKA) can be indicated, during the adolescent years, in patients with advanced JRA to alleviate pain and improve function. Because of the relative infrequency of TKA in patients with JRA, evaluation of the type of TKA performed and the results merit review. Methods: This case report presents a nineteen year old male with advanced JRA and severe knee flexion contractures who received bilateral knee replacement in an effort to achieve ambulation. Two distinct operations were performed to obtain full extension: 1. Distal femoral resection with conversion to hinged arthroplasty. 2. Femoral shortening osteotomy with total knee arthroplasty with revision components. Results: Both methods resulted in intraoperative full extension of the knee, yet the second method preserved more bone stock and avoided the use of a hinge. Conclusions: In our review of the literature, we were unable to locate a surgical correction of a flexion contracture of this severity. This case outlines at least some of the challenges and limitations in correction of such contractures and provides a novel and straight forward surgical solution in overcoming these challenges.