Revision Total Knee Arthroplasty for Juvenile Idiopathic Arthritis: Implant Survivorship and Clinical Outcomes the Second Time Around.
Academic Article
Overview
abstract
BACKGROUND: Juvenile idiopathic arthritis (JIA) is a rare disease that oftentimes requires treatment with total knee arthroplasty (TKA). Although 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 multicenter 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 5 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 threshold. Risk factors for rerevision included the use of constrained prostheses (hazards ratio: 6.0, 95% CI [1.3 to 28.6], P = 0.025). The most common reasons for rerevision were implant loosening/instability (eight TKAs, 40%), pain/synovitis (eight TKAs, 40%), and infection (four TKAs, 20%). CONCLUSIONS: Revision TKA implant survivorship for JIA patients is modest at 10 and 20 years after surgery. Patient-reported outcomes were similar to those previously reported for revision TKA. Rerevision 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. LEVEL OF EVIDENCE: IV.
