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14. Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis

Author

Heyse, Thomas J, Ries, Michael D, Bellemans, Johan, Goodman, Stuart B, Scott, Richard D, Wright, Timothy M, Lipman, Jospeh D, Schwarzkopf, Ran, and Figgie, Mark P

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Pediatric, Arthritis, Clinical Research, Rehabilitation, Autoimmune Disease, Musculoskeletal, Inflammatory and immune system, Adolescent, Adult, Arthritis, Juvenile, Arthroplasty, Replacement, Knee, Child, Female, Humans, Knee Joint, Knee Prosthesis, Male, Middle Aged, Prosthesis Design, Prosthesis Failure, Treatment Outcome, Orthopedics, Clinical sciences
Abstract

BackgroundTotal knee arthroplasty (TKA) for juvenile idiopathic arthritis is rare but is nonetheless indicated for many patients with this disease. Few reports exist on the results of TKA in patients with juvenile idiopathic arthritis.Questions/purposesIt was sought to determine (1) survivorship and (2) functional outcomes of TKAs in patients with juvenile idiopathic arthritis.MethodsResults were combined from patients treated by experienced surgeons at five hospitals between 1979 and 2011. Two hundred nineteen patients (349 TKAs) were identified and contacted to survey their outcomes at a minimum followup of 2 years (mean, 12 ± 8 years; range, 2-33 years). The average age at surgery was 28.9 ± 9.7 years (range, 11-58 years). Data on revision surgery and ability to perform daily activities were collected.ResultsThe 10-year survivorship was 95%, decreasing to 82% by 20 years. At latest followup, 31 of 349 TKAs (8.9%) had been revised for either polyethylene failure or loosening (18 TKAs), infection (four), stiffness (three), periprosthetic fractures (two), bilateral amputation for vascular reasons (two), patellar resurfacing (one), and instability (one). Walking tolerance was unlimited in 49%, five to 10 blocks in 23%, and less than five blocks in 28%. Eleven percent could not manage stairs, and another 59% depended on railings. A cane was used by 12% and crutches by 7%; 12% were wheelchair-dependent.ConclusionsTKA survivorship in patients with juvenile idiopathic arthritis was inferior to that typically seen in younger patients with osteoarthritis or even rheumatoid arthritis confirming results of earlier studies with smaller patient numbers. This is especially disconcerting because younger patients require better durability of their TKAs.

Published
2014

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