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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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Barik S, Jain A, Chanakya PV, Raj V, Goyal T. What has changed in total hip arthroplasty in patients of juvenile idiopathic arthritis since 2000? A systematic review and pooled data analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2737-2748. [PMID: 36947313 DOI: 10.1007/s00590-023-03525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16-150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA. METHODS Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included. RESULTS The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10-33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8-25%) as compared to 4% (95% CI 1-6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared. CONCLUSION JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
| | - Aakash Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - P V Chanakya
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Tarun Goyal
- Department of Orthopedics, All India Institute of Medical Sciences, Bhatinda, India
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Cho MR, Jun CM, Kim KT, Song SK, Choi WK. Results of primary THA using 36 mm femoral heads on first-generation highly cross-linked polyethylene in patients less than 60 years of age: Minimum 10-year follow-ups. J Orthop Surg (Hong Kong) 2020; 28:2309499019896448. [PMID: 31903855 DOI: 10.1177/2309499019896448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Long-term results of total hip arthroplasty (THA) using highly cross-linked polyethylene (HXLPE) and metal femoral head with more than 10 years of follow-up have already been reported. However, most studies included results with a head size of 28 mm that could affect wear rates. The aim of this study was to evaluate the results of 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age with a minimum follow-up of 10 years. METHODS Retrospective analysis included 54 cases from 47 patients. The mean age at the time of surgery was 47.22 years and the mean follow-up period was 131.04 months. Porous-coated cementless acetabular cups (Trilolgy®; Zimmer Inc., Warsaw, Indiana, USA) and HXLPE acetabular liners (Longevity®; Zimmer Inc.) were used for all cases. Acetabular cup abduction angles, anteversion angles, and wear rates of liner were measured using polyWare pro 3D distal version 5.10. RESULTS The average modified Harris hip score at the final follow-up was 88.48 (range 80-96). Average Merle d'Aubigne and Postel score was 15.57 (range 14-18). There was no acetabular cup or femoral stem failing due to aseptic loosening. The average steady-state wear rate determined using radiographs taken at 1 year postoperatively and at the latest follow-up was 0.053 ± 0.025 mm/year. There were no statistically significant differences in liner wear rate with respect to age, variety of the femoral stem, or liner thickness. CONCLUSION Results of THA with 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age were satisfactory.
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Affiliation(s)
- Myung-Rae Cho
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Chung-Mu Jun
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Kyung-Tae Kim
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Suk Kyun Song
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Won-Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
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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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Ibrahim EF, Rashid A, Thomas M. Resurfacing hemiarthroplasty of the shoulder for patients with juvenile idiopathic arthritis. J Shoulder Elbow Surg 2018; 27:1468-1474. [PMID: 29567037 DOI: 10.1016/j.jse.2018.02.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/27/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study reports the outcome of resurfacing hemiarthroplasty (RHA) in a cohort of patients with juvenile idiopathic arthritis (JIA) affecting the shoulder joint METHODS: Fourteen uncemented RHA procedures were performed for 11 consecutive patients who required surgery because of JIA. Mean age at surgery was 36.4 years. Mean clinical follow-up was 10.4 years (range, 5.8-13.9 years). A significant humeral head defect (up to 40% surface area) was found in 5 shoulders and filled with autograft from the distal clavicle or femoral head allograft. RESULTS At latest follow-up, no patient required revision. There was excellent relief from pain. The mean Oxford Shoulder Score and Constant-Murley Score improved significantly. No shoulder had a poor outcome, and 6 had a very good or excellent outcome. Worse outcome was associated with an intraoperative finding of significant humeral head erosion. Two shoulders required early arthroscopic subacromial decompression, but there were no other reoperations. There were no instances of radiographic implant loosening or proximal migration. Painless glenoid erosion was seen in 5 shoulders but was not associated with worse outcome. CONCLUSIONS The midterm results of RHA for JIA are at least comparable to those for stemmed hemiarthroplasty, with the added benefit of bone conservation.
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Affiliation(s)
- Edward F Ibrahim
- Wexham Park and Heatherwood Hospitals, Frimley Health National Health Service Foundation Trust, Slough, Berkshire, UK.
| | | | - Michael Thomas
- Wexham Park and Heatherwood Hospitals, Frimley Health National Health Service Foundation Trust, Slough, Berkshire, UK
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Tang X, Zhu J, Zhou Z, Shen B, Kang P, Pei F, Li J. Total hip replacement in adult patients with severe Kashin-Beck disease of the hip. BMC Musculoskelet Disord 2016; 17:289. [PMID: 27422624 PMCID: PMC4946233 DOI: 10.1186/s12891-016-1119-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/09/2016] [Indexed: 02/05/2023] Open
Abstract
Background The treatment of elderly patients with Kashin-Beck disease (KBD) remains clinically challenging, and clinical data are very lacking. The aim of this study was to retrospectively evaluate pain and functional outcomes following total hip replacement in adult patients with severe KBD of the hip. Methods Twenty-two patients (32 hips) with KBD underwent primary hip replacement and were followed for at least 2 years. Radiographic and Clinical assessments were evaluated for each patient at 2 and 4 weeks and at 3, 6 and 12 months after the operation and annually thereafter. The efficacy index included the visual analogue scale (VAS) score, Harris hip score, functional score for adult Tibetans with Kashin-Beck Disease (FSAT-KBD) and radiographic outcomes. Results The patients underwent a follow-up, and the mean follow-up time was 3.8 years. VAS scores significantly decreased within the first 6 months postoperatively. This decrease continued until the final follow-up (p < 0.01). This result was supported by a significant increase in the Harris and FSAT-KBD scores after the surgery (p < 0.01). At the final follow-up, there was no change in prosthesis positioning or radiographic evidence of prosthesis loosening. One case received impacted allograft bone croutons and had worn polyethylene components replaced after 6 years because the patient suffered severe pelvic and femoral osteolytic lesions postoperatively. Conclusions Hip replacement can relieve pain and improve joint function in treating severe KBD hip. Additional studies that are more extensive are needed to confirm the findings of our study.
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Affiliation(s)
- Xin Tang
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Jing Zhu
- Respiratory and Thoracic Surgery Ward, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Zongke Zhou
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China.
| | - Bin Shen
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Pengde Kang
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
| | - Fuxing Pei
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China.
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China
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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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Implant survival and patient-reported outcomes after total hip arthroplasty in young patients with juvenile idiopathic arthritis. J Arthroplasty 2015; 30:398-402. [PMID: 25449584 DOI: 10.1016/j.arth.2014.09.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 02/01/2023] Open
Abstract
Juvenile Idiopathic Arthritis (JIA) is a common rheumatologic disease that frequently involves the hip joint and requires treatment with total hip arthroplasty (THA). A retrospective study with prospective follow-up was conducted to determine implant survival and patient-reported outcomes in JIA patients aged 35 or younger treated with THA. This study included 56 patients, and the mean time to follow-up was 12 years. The 10-year implant survival was 85%, and implant survival was significantly longer in older patients (P value=0.04). Hip disability and osteoarthritis outcome (HOOS) scores were favorable at follow-up, but significantly worse in women and patients with custom implants or history of revision THA. Overall, patient factors and implant characteristics predict implant survival and outcomes after THA in young patients with JIA.
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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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