High complication rate in revision total hip arthroplasty in juvenile idiopathic arthritis.

Abstract

BACKGROUND:

Revision total hip arthroplasty (THA) in patients with juvenile idiopathic arthritis (JIA) is challenging as a result of the patient's young age, systemic disease, multiple affected joints, small proportions, and bone loss. The intermediate- to long-term results of these surgeries remain unknown.

QUESTIONS/PURPOSES:

The purpose of this study is to determine the (1) functional outcomes; (2) surgical complications; and (3) frequency of reoperation or revision after revision THA for JIA.

METHODS:

We reviewed the records of all patients from one center who underwent revision THA for JIA who had a minimum of 5 years of followup (mean, 9 years; range, 5-19 years). This resulted in a series of 24 revision THAs in 15 patients. All patients were Charnley Class C. Age at revision averaged 35 years (range, 21-53 years). The 20 acetabular and 12 femoral revision components included 15 cementless cups, five reconstruction/roof rings with a cemented cup, and four cemented and eight cementless femoral stems.

RESULTS:

The Harris hip scores improved from 54 (range, 34-85) to 77 (range, 37-100) (p < 0.001). Complications included two proximal femoral fractures associated with severe osteolysis and one sciatic nerve palsy in a patient with severe acetabular deficiency. A total of seven hips (29%) required reoperation or revision surgery, including three for infection (one early and two late) and four for mechanical loosening.

CONCLUSIONS:

Revision THA in JIA is very challenging owing to patients' small proportions and compromised bone stock. The intraoperative and early complication rates are relatively high. Prognosis for long-term survivorship is guarded; limiting factors include periprosthetic osteolysis associated with older implants that used conventional polyethylene and cemented stems.

• Authors: Stuart B Goodman, Katherine Hwang, Susanna Imrie
• Journal: Clinical orthopaedics and related research (Clin Orthop Relat Res) Vol. 472 Issue 2 Pg. 637-44 (Feb 2014) ISSN: 1528-1132 [Electronic] United States
• PMID: 24136805 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Arthritis, Juvenile (diagnostic imaging, physiopathology, surgery)
• Arthroplasty, Replacement, Hip (adverse effects, instrumentation)
• Biomechanical Phenomena
• Child
• Child, Preschool
• Female
• Hip Joint (diagnostic imaging, physiopathology, surgery)
• Hip Prosthesis (adverse effects)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Prosthesis Design
• Prosthesis Failure
• Prosthesis-Related Infections (etiology, surgery)
• Radiography
• Recovery of Function
• Reoperation
• Time Factors
• Treatment Outcome
• Young Adult