Simultaneous Quadruple Joint Replacement (QJR) in Disabling Juvenile Rheumatoid Arthritis – a Case Report with Review of Literature

Document Type : CASE REPORT


All India Institute of Medical Sciences (AIIMS), New Delhi, India


We wish to present a case of 47-year-old patient with Juvenile Rheumatoid Arthritis and ankylosis of both hips and both
knees treated by bilateral hip and knee arthroplasty in a single anaesthesia i.e. Quadruple joint replacement in single
sitting. He was back on his feet from his bed-ridden state within the fortnight following surgery. He has been followed
up for four years and has been performing his activities of daily living independently. We discuss the preoperative
planning, surgical details and post-operative rehabilitation and unique challenges pertaining to this case.
Level of evidence: IV


Main Subjects

1. Mulhall KJ, Saleh KJ, Thompson CA, Severson EP,
Palmer DH. Results of bilateral combined hip and
knee arthroplasty in very young patients with
juvenile rheumatoid arthritis. Arch Orthop Trauma
Surg. 2008; 128(3):249–54.
2. Jolles BM, Bogoch ER. Juvenile arthritis patients report
favorable subjective outcomes of hip arthroplasty
despite poor standard outcome scores. J Arthroplasty.
2012; 27(9):1622–8.
3. Li XA, Iyer S, Cross MB, Figgie MP. Total joint
replacement in adolescents: literature review and
case examples. Curr Opin Pediatr. 2012; 24(1):57–63.
4. Kilgus DJ, Amstutz HC, Wolgin MA, Dorey FJ. Joint
replacement for ankylosed hips. J Bone Joint Surg Am.
1990; 72(1):45–54.
5. Siavashi B, Mohseni N, Zehtab MJ, Ramim T. Clinical
outcomes of total hip arthroplasty in patients with
ankylosed hip. Arch Bone Jt Surg. 2014; 2(1):25-30.
6. Hardinge K, Williams D, Etienne A, MacKenzie D,
Charnley J. Conversion of fused hips to low friction
arthroplasty. J Bone Joint Surg Br. 1977; 59-B(4):
7. Strathy GM, Fitzgerald RH Jr. Total hip arthroplasty in
the ankylosed hip. A ten-year follow-up. J Bone Joint
Surg Am. 1988; 70(7):963–6.
8. Naranja RJ Jr, Lotke PA, Pagnano MW, Hanssen AD.
Total knee arthroplasty in a previously ankylosed
or arthrodesed knee. Clin Orthop Relat Res. 1996;
9. Scott RD. Total hip and knee arthroplasty in juvenile 
rheumatoid arthritis. Clin Orthop Relat Res. 1990;
10. Aghayev E, Beck A, Staub LP, Dietrich D, Melloh
M, Orljanski W, et al. Simultaneous bilateral hip
replacement reveals superior outcome and fewer
complications than two-stage procedures: a
prospective study including 1819 patients and 5801
follow-ups from a total joint replacement registry.
BMC Musculoskelet Disord. 2010; 11:245-55.
11. Johnston LR, Clift BA, Abboud RJ. Bilateral
simultaneous hip replacement versus bilateral
sequential hip replacement. A 7-year data review.
Orthop Nurs. 2011; 30(2):119–23.
12. Pfeil J, Höhle P, Rehbein P. Bilateral endoprosthetic
total hip or knee arthroplasty. Dtsch Ä􀇆 rztebl Int. 2011;
13. Schwarzkopf R, Olivieri P, Jaffe WL. Simultaneous
bilateral total hip arthroplasty with hydroxyapatitecoated
implants: a 20-year follow-up. J Arthroplasty.
2012; 27(7):1364–9.
14. Malviya A, Foster HE, Avery P, Weir DJ, Deehan DJ.
Long term outcome following knee replacement
in patients with juvenile idiopathic arthritis. Knee.
2010; 17(5):340–4.
15. Pakos EE, Paschos NK, Xenakis TA. Long term
outcomes of total hip arthroplasty in young patients
under 30. Arch Bone Jt Surg. 2014; 2(3):157-62.
16. Bangjian H, Peijian T, Ju L. Bilateral synchronous total
hip arthroplasty for ankylosed hips. Int Orthop. 2012;
17. Jolles BM, Bogoch ER. Quality of life after TKA for
patients with juvenile rheumatoid arthritis. Clin
Orthop Relat Res. 2008; 466(1):167–78.
18. Bhan S, Eachempati KK, Malhotra R. Primary
cementless total hip arthroplasty for bony ankylosis
in patients with ankylosing spondylitis. J Arthroplasty.
2008; 23(6):859–66.
19. Bhan S, Rath S. Modified posterior soft tissue release
for management of severe knee flexion contracture.
Orthopedics. 1989; 12(5):703–8.
20. Yoshino S, Fujimori J, Morishige T, Uchida S. Bilateral
joint replacement of hip and knee joints in patients
with rheumatoid arthritis. Arch Orthop Trauma Surg.
1984; 103(1):1–4.
21. Jergesen HE, Poss R, Sledge CB. Bilateral total hip and
knee replacement in adults with rheumatoid arthritis:
an evaluation of function. Clin Orthop Relat Res. 1978;
22. Ranawat CS, Bryan WJ, Inglis AE. Total knee
arthroplasty in juvenile arthritis. Arthritis Rheum.
1983; 26(9):1140–4.