Revision Total Hip Arthroplasty in Juvenile Idiopathic Arthritis: Survivorship After a Mean Follow-up of 11 Years.

Abstract

Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition that often affects the hip joints during childhood. Due to the high incidence of failure of initial total hip arthroplasty (THA) performed years earlier for JIA, revision surgeries are frequently necessary and particularly challenging. This study evaluated the outcomes of these complex revision procedures after an average follow-up of 11 years.

Methods: A retrospective review of 24 patients (34 hips) who had JIA undergoing revision THA between January 1999 and December 2023 was conducted. The mean age of the cohort was 40 years (range, 17 to 61), with an equal number of men and women patients. All surgeries were performed by a single surgeon. Data sources included clinical records and surgical reports. Univariate analyses were performed using Mann-Whitney tests for continuous variables and Chi-square/Fisher's exact tests for categorical variables. Kaplan-Meier survival curves were generated to estimate reoperation-free survival.

Results: The Kaplan-Meier survival analysis showed reoperation-free survival rates of 54% at five years and 36% at 10 years. The 95% CI (confidence intervals) for these estimates were 31 to 93% and 17 to 80%, respectively. Univariate analyses revealed a significant association between complications and length of hospital stay (hazard ratio [HR]: 0.15; 95% CI: 0.03 to 0.72; P = 0.018). A total of 41.2% of patients experienced complications such as infection, nerve palsy, and dislocation.

Conclusions: Revision THA in patients who had JIA is associated with a high complication rate and reduced reoperation-free survival. Early identification of risk factors, meticulous surgical planning, and comprehensive postoperative care are critical to improving long-term outcomes.