Total Knee Arthroplasty in a Young Adult with Rheumatoid Arthritis: A Case Report

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease characterized by persistent synovial inflammation leading to progressive joint destruction, pain and disability. In advanced stages, total knee arthroplasty (TKA) becomes a definitive option. Performing TKA in younger patients is rare due to long term implant survival concerns. We report a 35-year-old woman with 1 year history of progressive right knee pain with stiffness and functional limitation. Laboratory findings show elevated rheumatoid factor, anti-CCP, ESR, and CRP. Physical examination revealed swelling, tenderness, and restricted range of motion. X-ray show joint space narrowing, erosions, and periarticular osteopenia. Considering failure of medical therapy and impaired quality of life, TKA was performed using a cruciate-retaining medial congruent (CR-MC) design through a medial parapatellar approach. Postoperative imaging confirmed accurate prosthesis alignment. At 2 weeks follow up, the patient report substantial pain reduction and was able to ambulate independently with aids. TKA is the gold standard for end-stage RA, yet its application in younger patients is uncommon due to higher functional demands, longer life expectancy, and increased risk of revision surgery. In this case, the decision to proceed with TKA was based on severe pain, radiographic evidence of advanced joint destruction, and substantial impairment of daily activities. A CR-MC prosthesis was chosen to preserve the function of the posterior cruciate ligament, enhance stability and replicate more natural knee movement. This configuration enables controlled femoral rollback and deeper flexion, potentially improving long-term satisfaction and extending the lifespan of the implant. This case report describes TKA in a young adult with RA unresponsive to conventional therapy. Early outcomes showed reduced pain and improved mobility. TKA may be considered in similar cases with careful planning, appropriate implant selection, and structured rehabilitation.