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Warren SI, Hwang KL, Lee JJ, Murrietta AJ, Koltsov JCB, Goodman SB. Primary Total Hip Arthroplasty in Juvenile Idiopathic Arthritis: Survivorship After a Median Follow-Up of 12 Years. J Arthroplasty 2024; 39:1530-1534. [PMID: 38104785 DOI: 10.1016/j.arth.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition of childhood that frequently affects the hip. Total hip arthroplasty (THA) in JIA can be challenging due to the patient's young age, small proportion, complex anatomy, and bone loss. Outcome data are limited. METHODS We reviewed prospectively collected data in 57 JIA patients (83 hips) who underwent THA between 1986 and 2020 by a single surgeon. The median patient age at surgery was 26 years (range, 14 to 62). Reoperation-free survival was assessed via the cumulative incidence function, accounting for the competing risk of death. Relationships between patient and implant factors and survivorship were evaluated by stratification of the cumulative incidence function and Gray's tests. Wilcoxon signed rank tests were used to assess the preoperative to latest postoperative change in patient-reported outcome measures. RESULTS At a median (interquartile range) of 12 (4, 20) years of follow-up, 13 (16%) patients underwent reoperation, most commonly for polyethylene wear and osteolysis (7 hips). The estimated incidence of 10-year, 20-year, and 30-year revision (95% confidence interval) were 11.3% (4.5, 21.6%), 18.5% (8.9, 30.9%), and 40.6% (19.4, 60.9%), respectively. There were no differences in survival based on patient age, sex, implant fixation method, polyethylene type, or thickness. All patient-reported outcome measures improved from preoperative to latest follow-up. CONCLUSIONS Primary THA is a durable and effective treatment for JIA patients with severe hip involvement and results in major improvements in pain and function. We did not identify any factors predictive of failure.
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Affiliation(s)
- Shay I Warren
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Katherine L Hwang
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Jonathan J Lee
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Adam J Murrietta
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Jayme C B Koltsov
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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Klein C, Barbier V, Glorion C, Gouron R. Surgical Treatment of Juvenile Idiopathic Arthritis in the Era of Novel Drug Therapies. J Clin Med 2023; 12:jcm12103402. [PMID: 37240508 DOI: 10.3390/jcm12103402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Juvenile idiopathic arthritis is the most common chronic rheumatic disease encountered in children under the age of sixteen and causes significant impairments in daily life. Over the last two decades, the introduction of new drug treatments (including disease-modifying antirheumatic drugs and biologics) has changed the course of this disease, thus reducing the indication for surgery. However, some patients fail to respond to drug therapy and thus require personalized surgical management, e.g., the local reduction of joint effusion or a synovial pannus (via intra-articular corticosteroid injections, synovectomy, or soft tissue release), and management of the sequelae of arthritis (such as growth disorders and joint degeneration). Here, we provide an overview of the surgical indications and outcomes of the following interventions: intra-articular corticosteroid injections, synovectomy, soft tissue release, surgery for growth disorders, and arthroplasty.
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Affiliation(s)
- Céline Klein
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital, University of Picardie Jules Verne, 80054 Amiens, France
- MP3CV-EA7517, CURS-Amiens University Hospital, Jules Verne University of Picardie, 80000 Amiens, France
| | - Vincent Barbier
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital, University of Picardie Jules Verne, 80054 Amiens, France
- MP3CV-EA7517, CURS-Amiens University Hospital, Jules Verne University of Picardie, 80000 Amiens, France
| | - Christophe Glorion
- Paediatric Orthopaedic Surgery Department, Necker University Hospital, Sorbonne Paris Cité, 75015 Paris, France
| | - Richard Gouron
- Department of Paediatric Orthopaedics, Amiens Picardie University Hospital, University of Picardie Jules Verne, 80054 Amiens, France
- MP3CV-EA7517, CURS-Amiens University Hospital, Jules Verne University of Picardie, 80000 Amiens, France
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Murotani Y, Fujita H, Hara H, Harada H, Kataoka M, Okutani Y. Good result for twelve years after bilateral hip and knee arthroplasties for ankylosis with juvenile idiopathic arthritis: a case report. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:185-199. [PMID: 35392010 PMCID: PMC8971032 DOI: 10.18999/nagjms.84.1.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 11/05/2022]
Abstract
Juvenile idiopathic arthritis (JIA) can lead to joint deformity and bone destruction, which can cause gait disturbances. To the best of our knowledge, there are no case reports with over 10 years of follow-up on quadruple joint arthroplasties (QJA) for bilateral hip and knee ankylosis associated with JIA. We present the case of a 29-year-old woman with JIA. The patient suffered from bilateral ankylosis of the hips and knees and developed a swing gait requiring double crutches. We performed staged QJA with careful attention to postoperative rehabilitation and her physical features, which included excessive pelvic anteversion, poor bone quality, and short statue of bones. Twelve years after surgery, the patient was able to walk without any support and showed good clinical functional scores. In addition, no radiological loosening following QJA was observed. We hereby introduce a surgical strategy for total hip arthroplasty for excessive pelvic anteversion, which involves two methods to calculate pelvic tilt on a pelvic anteroposterior radiograph. These methods were able to approximately predict postoperative pelvic changes.
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Affiliation(s)
- Yoshiki Murotani
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Center for Hip and Knee Arthroplasty, Rakuyo Hospital, Kyoto, Japan
| | - Hiroaki Hara
- Rehabilitation Center, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hideto Harada
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Masanao Kataoka
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yuki Okutani
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
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Ahmad S, Sajid I, Jameel J, Singh S, Singh S, Varshney A. Ten years' follow-up for cemented hip arthroplasty in patients <60 years of age with standardization of cementing technique: A multicentric study. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Sorokina LS, Avrusin IS, Raupov RK, Lubimova NA, Khrypov SV, Kostik MM. Hip Involvement in Juvenile Idiopathic Arthritis: A Roadmap From Arthritis to Total Hip Arthroplasty or How Can We Prevent Hip Damage? Front Pediatr 2021; 9:747779. [PMID: 34805045 PMCID: PMC8604160 DOI: 10.3389/fped.2021.747779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To describe the clinical characteristics of hip involvement in juvenile idiopathic arthritis (JIA) from arthritis to hip osteoarthritis (HOA) and total hip arthroplasty (THA). Study Design: Seven hundred fifty-three patients aged 2-17 years with JIA were included in the study. The comparison analysis was performed between the following subgroups: (i) JIA without hip involvement (n = 600; 79.7%) vs. JIA with hip involvement without HOA (n = 105; 13.9%), (ii) JIA with hip involvement with HOA, but without THA (n = 32; 4.3%) and JIA with hip involvement with HOA and with THA (n = 16; 2.1%). Clinical, laboratory characteristics and treatment regimens compared. Results: Hip involvement was present in 20.3% of patients. HOA was present in 6.4% (12*1,000 patient-years) of the entire JIA group and 31.4% of patients with hip involvement. Sixteen patients (2.1%; 4.0*1,000 patient-years) required THA. The following factors were associated with HOA: sJIA (OR = 3.6, p = 0.008; HR = 3.0, p = 0.002), delayed remission (OR = 4.2, p = 0.004; HR = 1.4, p = 0.538), delay in biologic therapy initiation (OR = 7.5, p = 0.00001; HR = 6.7, p = 0.002), alkaline phosphatase <165 U\l (OR = 4.1, p = 0.0003; HR = 5.2, p = 0.000004), treatment with corticosteroids (CS) (OR = 2.6, p = 0.008; HR = 1.2, p = 0.670), cumulative corticosteroids >2,700 mg (OR = 4.3, p = 0.032; HR = 1.4, p = 0.527). The following factors were associated with THA: delay in biologic treatment initiation (OR = 1.04, p = 0.0001; HR = 9.1, p = 0.034), delayed hip involvement (OR = 5.2, p = 0.002; HR = 3.0, p = 0.044), and methylprednisolone pulse therapy (OR = 10.8, p = 0.0000001; HR = 5.6, p = 0.002). Conclusion: Both sJIA and systemic CS, impaired calcium-phosphorus metabolism, and delayed hip arthritis are associated with HOA development in JIA. HOA is considered to be a severe adverse event of CS treatment, especially delayed hip involvement.
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Affiliation(s)
- Lubov S Sorokina
- Department of Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Ilia S Avrusin
- Department of Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Rinat K Raupov
- Department of Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia.,Leningrad Regional Children's Hospital, Saint Petersburg, Russia.,Saint Petersburg State Health Care Establishment the City Hospital, Saint Petersburg, Russia
| | | | - Sergey V Khrypov
- St. Petersburg Clinical Scientific and Practical Center of Specialized Types of Medical Aid (Oncological), Saint Petersburg, Russia
| | - Mikhail M Kostik
- Department of Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia.,Almazov National Research Medical Centre, Saint Petersburg, Russia
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Klinkhardt C, Tanaka P, Adriano A. Anesthesia for Patients with Juvenile Idiopathic Arthritis Current Practice: A Review. Open Orthop J 2020. [DOI: 10.2174/1874325002014010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Juvenile Idiopathic Arthritis is one of the most common chronic diseases in children. The disease affects one or multiple joints. Additionally, systemic involvement can be present either due to the condition itself or due to pharmacologic side effects resulting from treatment. This article reviews different aspects of perioperative management of patients with Juvenile Idiopathic Arthritis. It outlines the risks and difficulties secondary to articular damage, and also pharmacologic treatment strategies interfering with the anesthetic plan.
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7
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Goodman SB. The Hip in Juvenile Idiopathic Arthritis. Open Orthop J 2020. [DOI: 10.2174/1874325002014010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
The hip joint is commonly affected in Juvenile Idiopathic Arthritis (JIA), especially in cases of systemic polyarticular disease. Chronic synovitis of the hip leads to joint destruction, therefore, systemic and local control of the disease is of paramount importance. Non-steroidal anti-inflammatory drugs, Disease Modifying Anti-Rheumatic Drugs (DMARDs), biologics, intra-articular corticosteroid injections, and physical therapy are the mainstay for controlling ongoing inflammation and hip joint contractures. Synovectomy with soft tissue releases is useful in the early stages of the disease, when the joint cartilage is largely preserved. Total joint arthroplasty (THA) is successful in relieving pain, and improving function, ambulation and range of motion in end-stage degenerative arthritis. With improved designs of smaller prostheses and modern bearing couples, it is hoped that the longevity of THA will facilitate a more normal and enduring lifestyle.
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Halvorsen V, Fenstad AM, Engesæter LB, Nordsletten L, Overgaard S, Pedersen AB, Kärrholm J, Mohaddes M, Eskelinen A, Mäkelä KT, Röhrl SM. Outcome of 881 total hip arthroplasties in 747 patients 21 years or younger: data from the Nordic Arthroplasty Register Association (NARA) 1995-2016. Acta Orthop 2019; 90:331-337. [PMID: 31088343 PMCID: PMC6718182 DOI: 10.1080/17453674.2019.1615263] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The literature is scarce on the outcome of the youngest patients with total hip arthroplasties (THAs). We analyzed register data, revision risk, and related factors in patients 21 years or younger with THAs in the Nordic Arthroplasty Register Association (NARA). Patients and methods - We included all THA patients 21 years or younger reported during 1995 through 2016 to the Danish, Finnish, Norwegian, and Swedish hip arthroplasty registers and merged these into the NARA dataset. Primary outcome was any implant revision. Results - We identified 881 THAs in 747 patients. Mean age at primary surgery was 18 years (9-21). The indications for THA were pediatric hip diseases (33%), systemic inflammatory disease (23%), osteoarthritis (4%), avascular necrosis (12%), hip fracture sequelae (7%), and other diagnoses (21%). Unadjusted 10-year survival for all THAs was 86%. Comparison between indications showed no differences in survival. Uncemented implants were used most frequently. Survival for uncemented and cemented implants was the same adjusted for sex, indication, head size, and time period for primary surgery. Aseptic loosening was the main cause of revision. Interpretation - Both cemented and uncemented fixations seem to be a viable option in this age group, but with a lower implant survival than in older patient groups.
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Affiliation(s)
- Vera Halvorsen
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway; ,Correspondence:
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Registry, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Lars B Engesæter
- Norwegian Arthroplasty Registry, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Bergen, Norway;
| | - Lars Nordsletten
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway; ,University of Oslo, Oslo, Norway;
| | - Søren Overgaard
- Department of Orthopaedic Surgery, Traumatology and Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark; ,Danish Hip Arthroplasty Register, Denmark;
| | - Alma B Pedersen
- Danish Hip Arthroplasty Register, Denmark; ,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Sweden; ,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Sweden;
| | - Maziar Mohaddes
- The Swedish Hip Arthroplasty Register, Sweden; ,Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, University of Gothenburg, Sweden;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; ,The Finnish Arthroplasty Register, Finland;
| | - Keijo T Mäkelä
- The Finnish Arthroplasty Register, Finland; ,Department of Orthopaedics and Traumatology, Turku University Hospital, Turku
| | - Stephan M Röhrl
- Division of Orthopedic Surgery, Oslo University Hospital Ulleval, Oslo, Norway;
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9
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Bilateral Destructive Hip Disease from Untreated Juvenile Idiopathic Arthritis. Case Rep Orthop 2019; 2019:4593129. [PMID: 30963013 PMCID: PMC6431357 DOI: 10.1155/2019/4593129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/22/2019] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
We report a novel case of a pediatric patient with bilateral hip destruction from untreated Juvenile idiopathic arthritis (JIA). She was presented at the age of 9 with hip pain associated with bilateral acetabular dysplasia and a dislocated left femoral head. Only 1.5 years later, the patient developed complete destruction of the left femoral head and dislocated right femoral head. The authors have not identified literature describing a similar case report of bilateral femoral head destruction resulting from Persistent Oligoarticular JIA. Pediatric patients presenting with rapidly evolving destructive process should be evaluated for rheumatologic, infectious, and spinal etiologies.
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Makarewich CA, Anderson MB, Gililland JM, Pelt CE, Peters CL. Ten-year survivorship of primary total hip arthroplasty in patients 30 years of age or younger. Bone Joint J 2018; 100-B:867-874. [PMID: 29954212 DOI: 10.1302/0301-620x.100b7.bjj-2017-1603.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims For this retrospective cohort study, patients aged ≤ 30 years (very young) who underwent total hip arthroplasty (THA) were compared with patients aged ≥ 60 years (elderly) to evaluate the rate of revision arthroplasty, implant survival, the indications for revision, the complications, and the patient-reported outcomes. Patients and Methods We retrospectively reviewed all patients who underwent primary THA between January 2000 and May 2015 from our institutional database. A total of 145 very young and 1359 elderly patients were reviewed. The mean follow-up was 5.3 years (1 to 18). Logistic generalized estimating equations were used to compare characteristics and the revision rate. Survival was evaluated using Kaplan-Meier curves and hazard rates were created using Cox regression. Results The overall revision rate was 11% (16/145) in the very young and 3.83% (52/1359) in the elderly groups (odds ratio (OR) 2.58, 95% confidence interval (CI) 1.43 to 4.63). After adjusting for the American Society of Anesthesiologists (ASA) score, gender, and a history of previous surgery in a time-to-event model, the risk of revision remained greater in the very young (adjusted hazard ratio (HR) 2.48, 95% CI 1.34 to 4.58). Survival at ten years was 82% (95% CI, 71 to 89) in the very young and 96% (95% CI, 94 to 97) in the elderly group (p < 0.001). The very young had a higher rate of revision for complications related to metal-on-metal (MoM) bearing surfaces (p < 0.001). At last follow-up, the very young group had higher levels of physical function (p = 0.002), lower levels of mental health (p = 0.001), and similar levels of pain (p = 0.670) compared with their elderly counterparts. Conclusion The overall revision rate was greater in very young THA patients. This was largely explained by the use of MoM bearings. Young patients with non-MoM bearings had high survivorship with similar complication profiles to patients aged ≥ 60 years. Cite this article: Bone Joint J 2018;100-B:867-74.
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Affiliation(s)
- C A Makarewich
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - M B Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - J M Gililland
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - C E Pelt
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - C L Peters
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
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Kiran M, Johnston LR, Sripada S, Mcleod GG, Jariwala AC. Cemented total hip replacement in patients under 55 years. Acta Orthop 2018; 89:152-155. [PMID: 29345170 PMCID: PMC5901511 DOI: 10.1080/17453674.2018.1427320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - About 86,000 total hip replacements (THR) have been registered in patients under 55 years in the National Joint Registry of England and Wales (NJR). The use of uncemented implants has increased, despite their outcomes not having been proven to be significantly better than cemented implants in this registry. We determined the implant survivorship and functional outcomes of cemented THR in patients under 55 years at a minimum follow-up of 22 years. Patients and methods - 104 hips in 100 patients were included in this prospective study. Functional outcome was assessed using the Harris Hip Score and radiographs were assessed for implant failure and "at risk" of failure. Kaplan-Meier survivorship analysis was performed. Results - 89% of hips showed good to excellent results at final follow-up with a mean Harris Hip Score of 88 at a mean follow-up of 25 years. Revision was performed in 3/104 hips. 14 acetabular components and 4 femoral components were "at risk" of failure. The survivorship at minimum 22 years with revision for any reason as the end-point was 97% (95% CI 95-98). Interpretation - Cemented hip replacements perform well in young patients with good long-term functional and radiographic outcomes.
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12
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Uncemented total hip arthroplasty in patients younger than 20 years. J Orthop Sci 2016; 21:500-506. [PMID: 27075587 DOI: 10.1016/j.jos.2016.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/22/2016] [Accepted: 03/16/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Several diseases may lead to advanced hip disease and cause disabling symptoms in adolescents. In literature there is no consensus which is the optimal surgical treatment for young adults with end-stage osteoarthritis. The purpose of this study was to assess the clinical and radiological outcomes of uncemented total hip arthroplasty for the treatment of end-stage hip arthritis in patients younger than 20 years at a minimum follow-up of ten years. METHODS We have retrospectively evaluated 24 patients who were 20 years or younger and underwent uncemented total hip arthroplasty. Minimum follow-up was 10 years. Clinical outcome was measured using the Harris Hip Score, Western Ontario McMaster, and the Short-Form 36. Hip calcification was evaluated using Brooker classification, while osteolysis was examined at the final follow-up according to the subdivision of Gruen. RESULTS The mean preoperative Harris Hip Score was 36.94 points and improved to 92.3, and the mean preoperative WOMAC score improved from 84.72 to 28.45 The Mental Component score-SF-36 improved from a preoperative mean of 26.23 points to 58.96, while the Physical Component score-SF-36 improved from a preoperative mean of 26.38-49.95. All components were stable and osseo-integrated. Radiolucent lines were not present in any hips. We noted the presence of 4 calcifications. No patient needed implant revision. The only complication was an intraoperative femoral fracture. CONCLUSION Total hip arthroplasty is a safe and reliable procedure for the treatment of end-stage arthritis in the young that provides good to excellent mid-term results.
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13
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[Juvenile rheumatoid diseases: Endoprosthetic care of destroyed hip joints]. DER ORTHOPADE 2016; 44:531-7. [PMID: 25940873 DOI: 10.1007/s00132-015-3095-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with juvenile idiopathic arthritis (JIA) often suffer from involvement of the hip joints, with joint destruction and related functional limitations, making hip replacement necessary. OBJECTIVES To discover what special features are to be expected in patients with JIA and hip arthroplasty and what impact they have on surgical indication, choice of implant, and technique. METHODS Selective literature review and evaluation of our patient population. RESULTS Compared with osteoarthritis patients, JIA patients are on average much younger at the time of hip replacement. Owing to the onset of the disease in childhood or adolescence and the frequent glucocorticoid therapy, growth disorders or abnormal anatomical findings are common in these patients. Bone density is often reduced at an early age. The perioperative management of medication has to be planned. Special implants for patients with rheumatic diseases do not exist, but the above peculiarities of this group of patients should be considered for surgical procedure and choice of implant and material. Overall, the results of hip arthroplasty in juvenile rheumatic diseases, in terms of pain relief and functional improvement, are good. The limited life of the arthroplasty is problematic. CONCLUSIONS By relieving pain, improvement of the range of motion and activity level very high patient satisfaction is usually achieved by hip arthroplasty in JIA patients. In the case of involvement of the contralateral hip or the ipsilateral knee joint it may be useful to perform a simultaneous, single-stage joint replacement of both joints.
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Gharehdaghi M, Rahimi H, Eshraghi R, Mousavian A, Assadian M. Hip Arthroplasty and its Revision in a Child: Case Report and Literature Review. THE ARCHIVES OF BONE AND JOINT SURGERY 2015; 3:207-11. [PMID: 26213707 PMCID: PMC4507076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/30/2015] [Indexed: 03/26/2024]
Abstract
Juvenile idiopathic arthritis is the leading cause of hip replacement in young children. However, arthroplasty in this population is challenging with several concerns about quality of the growing bone, young age for revision surgery, and difficulties in potential several revisions. In this study we introduce a case of a 12-year old who is one of the youngest patients to undergo revision hip arthroplasty. The index operation was done as a hybrid replacement, cemented for stem and press fit for acetabular component. Two years later revision was done with severe femoral deficiency. This second procedure was challenging but with short-term promising results. So we reviewed the literature for arthroplasty in this young population regarding recent findings and trends. According to the literature survival of the prosthesis is longer with a cemented acetabular component and press fit stem; however, there are evidences that show poor outcome of joint replacement after the first revision in juvenile idiopathic arthritis patients.
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Affiliation(s)
- Mohammad Gharehdaghi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hasan Rahimi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Eshraghi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Mousavian
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Assadian
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Kim SJ, Kang DG, Park SB, Kim JH. Is Hemiresurfacing Arthroplasty for Osteonecrosis of the Hip a Viable Solution? J Arthroplasty 2015; 30:987-92. [PMID: 25662673 DOI: 10.1016/j.arth.2015.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/05/2014] [Accepted: 01/11/2015] [Indexed: 02/01/2023] Open
Abstract
We conducted a systematic review of published studies that evaluated the outcomes of hemiresurfacing arthroplasty (HRA) in patients with osteonecrosis (ON). A structured literature review of multiple databases referenced articles from 1950 to 2014. A total of 430 patients from 14 published studies were identified. The mean duration of follow-up after the HRA was 69 months. At the final follow-up, the mean postoperative Harris hip score was 85. Overall clinical success rate was 74%. A total of 102 (21%) revision surgeries were required after the index procedure. Our study has helped to further elucidate the outcomes of HRA in patients with ON. We believe that HRA in young, active patients is a viable option providing symptomatic relief and functional improvement.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, KEPCO Medical Foundation, KEPCO Medical Center, Dobong-Gu, Seoul, Korea
| | - Dong-Geun Kang
- Department of Orthopaedics, KEPCO Medical Foundation, KEPCO Medical Center, Dobong-Gu, Seoul, Korea
| | - Sung Bae Park
- Department of Orthopaedics, KEPCO Medical Foundation, KEPCO Medical Center, Dobong-Gu, Seoul, Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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Abdel MP, Figgie MP. Surgical management of the juvenile idiopathic arthritis patient with multiple joint involvement. Orthop Clin North Am 2014; 45:435-42. [PMID: 25199416 DOI: 10.1016/j.ocl.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is recognized as a heterogenous group of disorders in which the common factor is persistent arthritis in at least 1 joint occurring before the age of 16 years. Although conservative management with nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs can be effective, approximately 10% of JIA patients have end-stage degenerative changes requiring total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). This article discusses the overall epidemiology, coordination of care, and medical and surgical management of JIA patients undergoing THA and TKA.
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Affiliation(s)
- Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Mark P Figgie
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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