Objective This study aimed to evaluate the effects of total knee arthroplasty (TKA) for rheumatoid arthritis (RA) on both knee function and disease activity with an average 10-year follow-up period. Methods This retrospective study reviewed 61 RA patients who underwent primary TKA with a mean follow-up of 10.2 years (5 to 15 years). Clinical outcomes included knee function, assessed using the Knee Society Score (KSS), and RA disease activity, evaluated with the 28-Joint Disease Activity Score using C-reactive protein (DAS28-CRP) and the Clinical Disease Activity Index (CDAI). Medication use, including methotrexate, prednisolone, and biologic DMARDs, was also analyzed. Results TKA significantly improved knee function, with mean KSS knee and function scores increasing from 41.05 and 44.59 preoperatively to 84.26 (p < 0.05) and 71.92 (p < 0.05), respectively, at final follow-up. RA disease activity also improved, since DAS28-CRP decreased from 3.90 to 2.42 (p < 0.05), and CDAI decreased from 18.96 to 7.76 (p < 0.05) at final follow-up. Patients treated with biologic DMARDs had superior KSS function scores compared with those on non-biologic DMARDs at postoperative 5 years (p < 0.05) and final follow-up (p < 0.05). Conclusions TKA provides sustained improvements in knee function and reduces RA disease activity over the long term, highlighting its dual benefits for joint and systemic health. Combining TKA with biologic DMARDs may optimize outcomes, offering a comprehensive therapeutic approach for RA patients with severe knee involvement. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • Total knee arthroplasty (TKA) in rheumatoid arthritis provides sustained improvement in knee function over an average 10-year follow-up. • TKA also contributes to long-term reductions in systemic disease activity, demonstrating benefits beyond joint-level outcomes. • Patients receiving biologic DMARDs achieve superior functional outcomes, supporting the value of combining surgical and advanced pharmacological therapies. </entry> </row> </tbody> </tgroup> </Table>

Long-term knee function and disease activity outcomes of total knee arthroplasty in patients with rheumatoid arthritis: a retrospective study with an average 10-year follow-up

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发表日期：

2026年4月13日

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Ken Kumagai,
Daiki Tanaka,
Shuntaro Nejima,
Hyonmin Choe,
Hiroyuki Ike,
Naomi Kobayashi,
Kengo Harigane,
Yuichi Mochida,
Yutaka Inaba

摘要

Objective

This study aimed to evaluate the effects of total knee arthroplasty (TKA) for rheumatoid arthritis (RA) on both knee function and disease activity with an average 10-year follow-up period.

Methods

This retrospective study reviewed 61 RA patients who underwent primary TKA with a mean follow-up of 10.2 years (5 to 15 years). Clinical outcomes included knee function, assessed using the Knee Society Score (KSS), and RA disease activity, evaluated with the 28-Joint Disease Activity Score using C-reactive protein (DAS28-CRP) and the Clinical Disease Activity Index (CDAI). Medication use, including methotrexate, prednisolone, and biologic DMARDs, was also analyzed.

Results

TKA significantly improved knee function, with mean KSS knee and function scores increasing from 41.05 and 44.59 preoperatively to 84.26 (p < 0.05) and 71.92 (p < 0.05), respectively, at final follow-up. RA disease activity also improved, since DAS28-CRP decreased from 3.90 to 2.42 (p < 0.05), and CDAI decreased from 18.96 to 7.76 (p < 0.05) at final follow-up. Patients treated with biologic DMARDs had superior KSS function scores compared with those on non-biologic DMARDs at postoperative 5 years (p < 0.05) and final follow-up (p < 0.05).

Conclusions

TKA provides sustained improvements in knee function and reduces RA disease activity over the long term, highlighting its dual benefits for joint and systemic health. Combining TKA with biologic DMARDs may optimize outcomes, offering a comprehensive therapeutic approach for RA patients with severe knee involvement.

Key Points

• Total knee arthroplasty (TKA) in rheumatoid arthritis provides sustained improvement in knee function over an average 10-year follow-up.

• TKA also contributes to long-term reductions in systemic disease activity, demonstrating benefits beyond joint-level outcomes.

• Patients receiving biologic DMARDs achieve superior functional outcomes, supporting the value of combining surgical and advanced pharmacological therapies.