Skip to main content

Advertisement

SpringerLink
Log in

Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis

  • Symposium: 2013 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Total 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/purposes

It was sought to determine (1) survivorship and (2) functional outcomes of TKAs in patients with juvenile idiopathic arthritis.

Methods

Results 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.

Results

The 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.

Conclusions

TKA 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.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–B
Fig. 3A–C
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Behrens EM, Beukelman T, Gallo L, Spangler J, Rosenkranz M, Arkachaisri T, Ayala R, Groh B, Finkel TH, Cron RQ. Evaluation of the presentation of systemic onset juvenile rheumatoid arthritis: data from the Pennsylvania Systemic Onset Juvenile Arthritis Registry (PASOJAR). J Rheumatol. 2008;35:343–348.

    PubMed  Google Scholar 

  2. Bellemans J, Victor J, Westhovens R, Dequeker J, Fabry G. Total knee arthroplasty in the young rheumatoid patient. Acta Orthop Belg. 1997;63:189–193.

    CAS  PubMed  Google Scholar 

  3. Boublik M, Tsahakis PJ, Scott RD. Cementless total knee arthroplasty in juvenile onset rheumatoid arthritis. Clin Orthop Relat Res. 1993;286:88–93.

    PubMed  Google Scholar 

  4. Carmichael E, Chaplin DM. Total knee arthroplasty in juvenile rheumatoid arthritis. A seven-year follow-up study. Clin Orthop Relat Res. 1986;210:192–200.

    PubMed  Google Scholar 

  5. Crowder AR, Duffy GP, Trousdale RT. Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis. J Arthroplasty. 2005;20(Suppl 3):12–16.

    Article  PubMed  Google Scholar 

  6. Dalury DF, Ewald FC, Christie MJ, Scott RD. Total knee arthroplasty in a group of patients less than 45 years of age. J Arthroplasty. 1995;1:598–602.

    Google Scholar 

  7. Gill GS, Chan KC, Mills DM. 5- to 18-year follow-up study of cemented total knee arthroplasty for patients 55 years old or younger. J Arthroplasty. 1997;12:49–54.

    Article  CAS  PubMed  Google Scholar 

  8. Iesaka K, Kubiak EN, Bong MR, Su ET, Di Cesare PE. Orthopedic surgical management of hip and knee involvement in patients with juvenile rheumatoid arthritis. Am J Orthop. 2006;35:67–73.

    PubMed  Google Scholar 

  9. Jolles BM, Bogoch ER. Quality of life after TKA for patients with juvenile rheumatoid arthritis. Clin Orthop Relat Res. 2008;466:167–178.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kennedy LG, Newman JH, Ackroyd CE, Dieppe PA. When should we do knee replacements? Knee. 2003;10:161–166.

    Article  PubMed  Google Scholar 

  11. Knutson K, Robertsson O. The Swedish Knee Arthroplasty Register (www.knee.se). Acta Orthop. 2010;81:5–7.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Malviya A, Foster HE, Avery P, Weir DJ, Deehan DJ. Long term outcome following knee replacement in patients with juvenile idiopathic arthritis. Knee. 2010;17:340–344.

    Article  PubMed  Google Scholar 

  13. Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Long-term followup of posterior-cruciate-retaining TKR in patients with rheumatoid arthritis. Clin Orthop Relat Res. 2004;428:146–152.

    Article  PubMed  Google Scholar 

  14. Palmer DH, Mulhall KJ, Thompson CA, Severson EP, Santos ER, Saleh KJ. Total knee arthroplasty in juvenile rheumatoid arthritis. J Bone Joint Surg Am. 2005;87:1510–1514.

    Article  PubMed  Google Scholar 

  15. Parvizi J, Lajam CM, Trousdale RT, Shaughnessy WJ, Cabanela ME. Total knee arthroplasty in young patients with juvenile rheumatoid arthritis. J Bone Joint Surg Am. 2003;85:1090–1094.

    PubMed  Google Scholar 

  16. Paxton EW, Furnes O, Namba RS, Inacio MC, Fenstad AM, Havelin LI. Comparison of the Norwegian knee arthroplasty register and a United States arthroplasty registry. J Bone Joint Surg Am. 2011;93(Suppl 3):20–30.

    PubMed  Google Scholar 

  17. Sarokhan AJ, Scott RD, Thomas WH, Sledge CB, Ewald FC, Cloos DW. Total knee arthroplasty in juvenile rheumatoid arthritis. J Bone Joint Surg Am. 1983;65:1071–1080.

    CAS  PubMed  Google Scholar 

  18. Schrama JC, Espehaug B, Hallan G, Engesaeter LB, Furnes O, Havelin LI, Fevang BT. Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: a prospective, population-based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register. Arthritis Care Res (Hoboken). 2010;62:473–479.

    Article  PubMed  Google Scholar 

  19. Thomas A, Rojer D, Imrie S, Goodman SB. Cemented total knee arthroplasty in patients with juvenile rheumatoid arthritis. Clin Orthop Relat Res. 2005;433:140–146.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Denise Drinkwater for help with the data acquisition among the five centers and Ella Christoph for her support with manuscript submission.

Author information

Authors and Affiliations

  1. University Hospital Marburg, Marburg, Germany

    Thomas J. Heyse MD

  2. University of California at San Francisco Medical Center, San Francisco, CA, USA

    Michael D. Ries MD

  3. University Hospital Leuven, Pellenberg, Belgium

    Johan Bellemans MD

  4. Stanford Medicine Outpatient Center, Redwood City, CA, USA

    Stuart B. Goodman MD

  5. Boston, MA, USA

    Richard D. Scott MD

  6. Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA

    Timothy M. Wright PhD & Jospeh D. Lipman MSc

  7. Orthopaedic Department, University of California, Irvine, CA, USA

    Ran Schwarzkopf MD

  8. Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA

    Mark P. Figgie MD

Authors
  1. Thomas J. Heyse MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael D. Ries MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johan Bellemans MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stuart B. Goodman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard D. Scott MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Timothy M. Wright PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jospeh D. Lipman MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ran Schwarzkopf MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mark P. Figgie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark P. Figgie MD.

Additional information

One or more of the authors (TJH) has been paid for consultancy work for and receives research support from Smith & Nephew (Memphis, TN, USA; USD < 10,000). One or more of the authors (MDR) has been paid for consultancy work for Stryker (Kalamazoo, MI, USA) and Smith & Nephew; has patents with Smith & Nephew and Stryker; has received royalties from Smith & Nephew; and has stock in OrthAlign (Aliso Viejo, CA, USA). One or more of the authors (JB) has been paid for consultancy work for Smith & Nephew, Stryker, Corin (Cirencester, UK), and Bluebelt Technology (Pittsburgh, PA, USA). Catholic University of Leuven (Flanders, Belgium) has received payment for one of the author’s (JB) lectures for Stryker, Zimmer (Warsaw, IN, USA), and Biomet (Warsaw, IN, USA). One or more of the authors (SBG) is on the board for the Journal of Arthroplasty, Clinical Orthopaedics and Related Research, Journal of Biomedical Materials Research, and Biomaterials and is the Chairman of the AAOS Biological Implants Committee. Moneys paid were for CORR® Deputy Editorship only. One or more of the authors (SBG) is employed by the Association of Bone and Joint Surgeons (CORR®). This author’s institution has received grant money from the National Institutes of Health (Bethesda, MD, USA) and Baxter (Deerfield, IL, USA). One or more of the authors (SBG) has stock in Biomimedica (South San Francisco, CA, USA), Biomimetic Therapeutics (Franklin, TN, USA), StemCor (London, UK), Accelalox (Menlo Park, CA, USA), and Tibion (Fremont, CA, USA). This author received money for travel expenses for travel to international Orthopaedic Society Meetings in Taiwan and China. One or more of the authors (RDS) has been paid for consultancy work and patents and received royalties from DePuy, Inc (Warsaw, IN, USA) and has stock in Conformis, Inc (Bedford, MA, USA). One or more of the authors (TMW) has received royalties from Mathys ABG (Bettlach, Switzerland) and has stock in Exactech (Great Neck, NY, USA). One or more of the authors (JDL) has been paid for consultancy work for Ivy Sports Medicine (Montvale, NJ, USA) and is the Director of Device Development at the Hospital for Special Surgery (New York, NY, USA); has received a National Institutes of Health grant for the Hospital for Special Surgery for the study “Improving the Performance of Total Elbow Replacement.” The Hospital for Special Surgery has received payment from Stryker contingent on this author writing a manuscript. One or more of the authors (JDL) has received money for patents licensed to Exactech, Mathys Inc, and Wright Medical (Arlington, TN, USA). He has additional unlicensed patents for various implant systems and receives royalties from Mathys Inc and Ortho Development Corp (Draper, UT, USA). His travel and accommodations in 2010, 2011, and 2012 at an annual meeting were paid for by the Chinese Orthopaedic Association (Beijing, China). The Hospital for Special Surgery received grant funding from Ethicon. One or more of the authors (MPF) has stock in Mekanika (Boca Raton, FL, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Data were collected at the University of California at San Francisco Medical Center, San Francisco, CA, USA; University Hospital Leuven, Pellenberg, Belgium; Stanford Medicine Outpatient Center, Redwood City, CA, USA; Brigham and Women’s Hospital Physician Organization, Boston, MA, USA; and the Hospital for Special Surgery, New York, NY, USA. Data analysis was conducted at the Hospital for Special Surgery, New York, NY, USA.

About this article

Cite this article

Heyse, T.J., Ries, M.D., Bellemans, J. et al. Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis. Clin Orthop Relat Res 472, 147–154 (2014). https://doi.org/10.1007/s11999-013-3095-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3095-3

Keywords

Search

Navigation