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.
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.
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