Revision Total Knee Arthroplasty for Juvenile Idiopathic Arthritis: Implant Survivorship and Clinical Outcomes the Second Time Around.

IF 3.4 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty Pub Date : 2025-03-17 DOI:10.1016/j.arth.2025.03.019

Ryan Cheng, Francesca R Coxe, Yu-Fen Chiu, Hannah Szapary, Katherine Hwang, Antonia F Chen, Stuart Goodman, Vivek M Shah, Mark P Figgie, Jason L Blevins

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引用次数: 0

Abstract

Background: Juvenile idiopathic arthritis (JIA) is a rare disease that oftentimes requires treatment with total knee arthroplasty (TKA). While studies have examined the outcomes of primary TKA for this cohort, the literature on 10- and 20-year revision TKA implant survivorship and clinical outcomes is limited.

Methods: A multi-center retrospective review identified 63 patients who underwent 70 revision TKAs between June 1, 1987, and September 30, 2020. The primary and secondary outcomes of interest were long-term implant survivorship and clinical outcomes, respectively. Patient-reported outcomes were assessed between April 1, 2020, and December 31, 2022. The average age was 47 years (range, 21 to 75). The mean follow-up was 12 years (range, 1.2 to 32.8) for both implant survivorship and patient-reported outcomes.

Results: Implant survivorship for revision TKA in JIA patients was 86% (95% Confidence Interval (CI): 77 to 94) at five years, 75% (95% CI: 65 to 86) at 10 years, and 70% (95% CI: 59 to 81) at 20 years. The mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score was 72.8 ± 16.1 points, with 53% (18 of 34 patients, 21 of 38 TKAs) reaching the KOOS JR patient acceptable symptom state (PASS) threshold. Risk factors for re-revision included the use of constrained prostheses (Hazards Ratio (HR): 6.0, 95% CI [1.3 to 28.6], P = 0.025). The most common reasons for re-revision were implant loosening/instability (eight TKAs, 40%), pain/synovitis (eight TKAs, 40%), and infection (four TKAs, 20%).

Conclusion: Revision TKA implant survivorship for JIA patients is modest at 10 years and 20 years after surgery. Patient-reported outcomes were similar to those previously reported for revision TKA. Re-revision risk increased with higher levels of constraint. Surgeons should be aware of these outcomes and risk factors when counseling and treating these patients the second time around.

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青少年特发性关节炎的改良全膝关节置换术：第二次植入物存活和临床结果。

背景：幼年特发性关节炎（JIA）是一种罕见的疾病，通常需要全膝关节置换术（TKA）治疗。虽然研究已经检查了原发性TKA的结果，但关于10年和20年TKA植入物生存率和临床结果的文献是有限的。方法：一项多中心回顾性研究确定了1987年6月1日至2020年9月30日期间接受70例tka翻修的63例患者。研究的主要和次要结果分别是长期种植体存活和临床结果。在2020年4月1日至2022年12月31日期间评估患者报告的结果。平均年龄为47岁（21 - 75岁）。对于种植体存活和患者报告的结果，平均随访时间为12年（1.2 - 32.8年）。结果：JIA患者改良TKA的种植体5年生存率为86%(95%可信区间（CI）： 77 - 94)， 10年生存率为75% (95% CI: 65 - 86)， 20年生存率为70% （95% CI: 59 - 81）。膝关节损伤和骨关节炎结局评分（kos JR）平均评分为72.8±16.1分，53%（34例患者中18例，38例tka中21例）达到kos JR患者可接受症状状态（PASS）阈值。再次翻修的危险因素包括使用受限假体（风险比（HR）： 6.0, 95% CI [1.3 ~ 28.6], P = 0.025）。再次翻修最常见的原因是种植体松动/不稳定（8例tka， 40%），疼痛/滑膜炎（8例tka， 40%）和感染（4例tka， 20%）。结论：改良TKA种植体在JIA患者术后10年和20年生存率一般。患者报告的结果与先前报道的修订TKA相似。再修订风险随着约束水平的提高而增加。外科医生在第二次咨询和治疗这些患者时应该意识到这些结果和风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Arthroplasty 医学-整形外科

CiteScore

7.00

自引率

20.00%

发文量

734

审稿时长

48 days

期刊介绍： The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.