ORTHOPAEDIC MANAGEMENT IN EXTREME GENU VALGUM AND RECURVATUM IN A PATIENT WITH RHEUMATOID ARTHRITIS

A case of acquired severe genu valgum and genu recurvatum in a patient with rheumatoid arthritis (RA) is here reported. The pain and genu valgum progressed because of poor RA control. The patient had no history of major trauma of the knee before or after the onset of RA. The most reasonable hypothesis to explain this patient‘s pathology is that occult genu recurvatum developed after a minor trauma and progressed; poor RA control then worsened the stability, the osteopenia and genu valgum, in the end the patient acquired a severe genu valgum with extreme values of the tibiofemoral axes (TFM), with multiplanar knee laxity and important bone destruction. Total knee arthroplasty (TKA) was successfully performed using a constrained hinged prosthesis. One year after the surgery, the patient exhibited improvement in her Knee Society Score from preoperative scores of 19 to postoperative scores of 91, no early or late signs of infection occurred, no early signs of loosening were noted either. Acquired global ligamentous deficiency with hyperextension instability (genu recurvatum) associated with severe genu valgum in patients with RA is rare. Excellent results were obtained with TKA, but the use of the most constrained prosthesis due to massive bone loss and ligamentous deficiency comes with the disadvantages of early aseptic loosening as a result of increased constrained compared to an unconstrained design.