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more susceptible to infections. We do not
change the antibiotic prophylaxis in these
patients, but the surgeon must be aware and
consider any sign of infection, in order to treat
it early and prevent loss of the arthroplasty.
The multi-joint involvement is very common
in all rheumatic patients, so it is imperative to
review the entire lower limb before indicating
knee arthroplasty, in particular the hip, once the
hip is the parameter for positioning the knee
prosthesis. Therefore hip arthroplasty must be
performed prior to the knee in the event that the
two joints are compromised.
Also in relation to the multi-joint involvement
in rheumatoid arthritis, special attention must
be taken concerning the cervical spine. The
manipulation of the cervical spine during
general anaesthesia can lead to subluxation C1-
C2 due to the involvement of the transverse
ligament of the odontoid.
Cases of fixed severe flexing of the knee can be
corrected with a surgery prior for the release of
the soft tissues and subsequent realization of
the arthroplasty later on appropriate time.
Still concerning patients with rheumatoid
arthritis, there is greater fragility of the soft
tissue and greater osteopenia due to the disease
itself and the effect of chronically administered
medications. During the surgery, in conse
quence, there should be more caution when
handling soft tissues, particularly in relation to
the insertion of the patellar tendon as well as
the manipulation of bone tissue in order to
avoid fractures or cause increased bone loss.
Patients with juvenile rheumatoid arthritis have
very short stature and very small bones. When
an indication for arthtoplasty require special
unconventional prostheses sized. This is a large
demand that challanges the Brazilian
orthopaedic surgeon, due to the lack of a
industry that provides suitable equipment for
the manufacture of this type of prosthesis.
Patients with systemic lupus erythematosus
have an even greater soft tissue involvement
and a tendency to a much greater stiffness.
Most of these patients may have partial pain
relief but can verify very little improvement in
terms of mobility of the joint, even though the
surgeon achieves enough free space to articulate
the knee intraoperatively.
Patients with gout tend to have large cavities in
bone defects that go unnoticed in radiologic
view. The surgeon must be aware of and comply
with these defects using bone graft or a revision
prosthesis.
In conclusion, the number of knee arthroplasties
in young patients in Brazil has increased in
recent years but is still very small. Patients with
sequelae of trauma or rheumatic disease have
needs, care and different expectations for the
knee replacement to be considered by the
orthopedic surgeon.