The total joint replacement of the four great human articulations concerns patients with extreme functional impairment of the locomotor system (musculoskeletal system). Most frequently this regards patients with rheumatoid arthritis (RA) or the ones treated operatively in childhood for DDH (Developmental Dysplasia/Dislocation of the Hip) or patients with idiopathic arthritis of the hip and knee.
Eight patients underwent total join replacement of both hips and both knees (four-joint arthroplasty) between 1986 and 2006. For six patients the cause of treatment was RA, for one patient it was an implication of DDH and for the last one it was an implication of idiopathic osteoarthritis of hips and knees. The operative treatment was a multistage process (during one operation only one joint was replaced). The mean age of the patient at the time of the last procedure was 51 years (range 36 to 70 years). The mean follow-up, of four-joint replacement, was 6 years). The mean follow-up of four-joint replacement, was 6 years. We based our outcome evaluation on clinical (HHS, KSS, WOMAC) and radiological examination.
The average preoperative Harris score for the group of patients was 35.3, WOMAC score--79.5, and Knee Society Score--38.1. After an average of 6 years follow-up all hips and knees were considered excellent, with average Harris score of 99.4, WOMAC Score of 4.5 and Knee Society Score of 98.3. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components and the femoral and tibial ones were correctly positioned with no radiographic evidence of loosening in the last examination.
Clinical and radiological evaluation of our material showed that total replacement of both hips and knees allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment.