Clinical Orthopaedics and Related Research®

, Volume 472, Issue 1, pp 147–154 | Cite as

Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis

  • Thomas J. Heyse
  • Michael D. Ries
  • Johan Bellemans
  • Stuart B. Goodman
  • Richard D. Scott
  • Timothy M. Wright
  • Jospeh D. Lipman
  • Ran Schwarzkopf
  • Mark P. Figgie
Symposium: 2013 Knee Society Proceedings

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.

Keywords

Total Knee Arthroplasty Juvenile Idiopathic Arthritis Revision Rate Patellar Resurface Simultaneous Bilateral Total Knee Arthroplasty 

Notes

Acknowledgments

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

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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Thomas J. Heyse
    • 1
  • Michael D. Ries
    • 2
  • Johan Bellemans
    • 3
  • Stuart B. Goodman
    • 4
  • Richard D. Scott
    • 5
  • Timothy M. Wright
    • 6
  • Jospeh D. Lipman
    • 6
  • Ran Schwarzkopf
    • 7
  • Mark P. Figgie
    • 8
  1. 1.University Hospital MarburgMarburgGermany
  2. 2.University of California at San Francisco Medical CenterSan FranciscoUSA
  3. 3.University Hospital LeuvenPellenbergBelgium
  4. 4.Stanford Medicine Outpatient CenterRedwood CityUSA
  5. 5.BostonUSA
  6. 6.Department of BiomechanicsHospital for Special SurgeryNew YorkUSA
  7. 7.Orthopaedic DepartmentUniversity of CaliforniaIrvineUSA
  8. 8.Adult Reconstruction and Joint Replacement DivisionHospital for Special SurgeryNew YorkUSA

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