Cemented Total Knee Arthroplasty in Patients with Juvenile Rheumatoid Arthritis

Thomas, Arthur N.; Rojer, David E; Imrie, Susanna; Goodman, Stuart B.

doi:10.1097/01.blo.0000151440.81939.c5

Cited by 16 publications

(14 citation statements)

References 15 publications

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“…Palmer et al [23] reported on eight patients undergoing TKA with a mean followup of 15.5 years, and three of 15 TKAs were rated as unsuccessful. Parvizi et al [24] reported on 13 patients undergoing TKA with a mean followup of 10.7 years, and Thomas et al [33] reported on 10 patients undergoing TKA with a mean followup of 6 years, but these studies did not comment on patient satisfaction. Lybäck et al [18] reported an overall ''subjective contentment'' of 75% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors have reported an improvement in range of motion. Boublik et al [4] reported a mean flexion arc improvement of 26°, with a mean postoperative flexion arc of 103°(range, 65°-135°); Carmichael and Chaplin [8] reported a mean postoperative flexion arc of 73°(range, 15°-120°), with a mean residual flexion contracture of 17°; Thomas et al [33] reported a mean flexion arc improvement of 33°, with a mean residual flexion contracture of 7°; and Palmer et al [23] reported a 43°increase in mean arc of motion (range, 36°-79°). However, Parvizi et al [24] reported TKA did not increase range of motion in a series of 15 patients younger than 20 years who underwent TKA, and Stuart and Rand [32] reported a modest decrease in knee flexion after TKA in 26 patients (44 knees) younger than 40 years.…”

Section: Discussionmentioning

confidence: 99%

“…Hargreaves et al [12] reported wound healing problems in 26% of patients with JRA. A search of computerized medical databases located 10 additional studies of outcomes of TKA in patients with JRA [4,7,8,18,23,24,26,29,32,33]. Unlike the reports of 55% to 80% improvement in pain after TKA in JRA [8,23,24,26,32,33], improvements in functional outcome measures and other instruments have been less positive than generally seen in TKA for osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

“…A search of computerized medical databases located 10 additional studies of outcomes of TKA in patients with JRA [4,7,8,18,23,24,26,29,32,33]. Unlike the reports of 55% to 80% improvement in pain after TKA in JRA [8,23,24,26,32,33], improvements in functional outcome measures and other instruments have been less positive than generally seen in TKA for osteoarthritis. These studies showed mean Knee Society scores from 82 to 92 and functional scores from 39 to 76 (on a scale of 0-100) at 4 to 6.5 years postoperatively [4,24,33], Jergensen's functional outcomes scores of 68 to 85 (on a scale of 0-100) [7,8], and Hospital for Special Surgery knee scores of 80 to 84 (on a scale of 0-100) [26,32].…”

Section: Introductionmentioning

confidence: 99%

“…A marked improvement in ambulation was reported after surgery. Whereas 88% to 100% of patients required walking aids or wheelchairs before surgery, 73% to 100% of patients did not require walking aids at 3.5 to 7 years' followup [7,8,24,25,33]. However, these studies did not analyze patient satisfaction or quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life After TKA for Patients With Juvenile Rheumatoid Arthritis

Jolles

Bogoch

2008

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Quality of Life After TKA for Patients With Juvenile Rheumatoid Arthritis

Jolles

Bogoch

2008

Clinical Orthopaedics &Amp; Related Research

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Juvenile idiopathic arthritis in adulthood and orthopaedic intervention

et al. 2009

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There have been marked changes in the management of juvenile idiopathic arthritis (JIA) over recent decades, mainly with earlier use of methotrexate (MTX). Our aim was to describe orthopaedic interventions in a large group of adults with JIA followed up over several decades. This was a retrospective observational study of adult JIA patients attending a teaching hospital clinic, with information collated on JIA subtype, disease duration, orthopaedic interventions, and exposure to MTX. The study included 144 patients with median disease duration of 19 years. Survival analysis showed that joint surgery was observed in the majority (75%) of patients with disease duration over 40 years with a trend for less joint surgery in patients with oligoarticular JIA. In total, 41 patients (28.5%) had received joint surgery, and 17/41 (41%) have required multiple procedures. Of those who have required joint surgery, 20/41 (48%) had started MTX in their adult years, with only 5/41 (12%), starting MTX prior to first joint replacement and none within 5 years of disease onset. Of the patients who have not had joint surgery to date, most (46/103, 45%) were receiving MTX or another immunosuppressive agent; in the majority of cases, MTX was started within 2 years of disease onset. Many adults with JIA require joint replacement surgery and ongoing immunosuppressive treatments, emphasising that JIA is not a benign disease. Many patients who have had joint replacement surgery have had exposure to MTX albeit after many years after disease onset; it remains to be seen whether patients who have received MTX therapy early in their disease course will ultimately have less requirement for joint surgery.

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La femoro-rotulea nell’artrite idiopatica giovanile

Viganò

Truzzi

Zanone

2008

Arch Ortop Reumatol

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e archivio di mento non venga compensato con il trattamento riabilitativo o corretto chirurgicamente [9]. Una volta che l'articolazione patello-femorale viene sovraccaricata e danneggiata, possono sovrapporsi una degenerazione dell'osso subcondrale [16], una tensione cronica del retinacolo [17], piccole lesioni nervose [18,19] e un incremento della sinovite [20]. Il processo sinovitico comporta la distensione dell'articolazione, caratterizzata da una componente liquida (liquido sinoviale) e da una componente solida (ipertrofia della membrana sinoviale). Questa distensione, soprattutto se mantenuta per lunghi periodi, porta a una progressiva lassità capsulo-legamentosa in generale e dei legamenti peri-rotulei in particolare; la rotula, inoltre, essendo sollevata rispetto alla troclea femorale, rimane meno guidata nei movimenti di flesso-estensione (soprattutto nei primi 30°) e tende a mantenere una posizione più laterale rispetto alla norma. Occorre inoltre ricordare che la AIG colpisce più frequentemente il sesso femminile (rapporto tra femmine e maschi circa 3:1), dove costituzionalmente il valgismo del ginocchio è più accentuato e più frequente è l'incidenza di patologia femoro-rotulea -iper-pressione esterna -anche in assenza di patologie infiammatorie. Nell'AIG è di frequente riscontro un valgo decisamente patologico [21]: l'incremento della vascolarizzazione conseguente all'infiammazione comporta un maggior stimolo sulla cartilagine di accrescimento meta-epifisaria distale del femore; tale stimolo è più accentuato medialmente e quindi si ha un accrescimento relativamente maggiore del condilo femorale mediale. Tutti gli elementi descritti concorrono al malallineamento dell'apparato estensore del ginocchio. Anche la posizione antalgica del ginocchio e dell'arto inferiore, se non tempestivamente contrastata e trattata, è in grado di portare sequele negative, prime fra tutte l'intrarotazione dell'anca, la flessione del ginocchio e la perdita del tono-trofismo muscolare, in particolare a carico del quadricipite. Il mantenimento di rapporti articolari abnormi durante una fase di maturazione scheletrica del ginocchio può comportare: displasia della troclea femorale, displasia rotulea, scompenso delle strutture capsulo-legamentose per retrazione, o rilasciamento, irreversibili. Se il riposo, il tempo, la riabilitazione e l'evoluzione della AIG non permettono un miglioramento della sintomatologia, allora sarà necessario provvedere a una soluzione chirurgica, in particolare in presenza di episodi di sublussazione o "tilt", che possono a lotenziali; -SFR con dolore; -SFR post-traumatiche. L'eziologia è comune ed è rappresentata dai dismorfismi muscololegamentosi e scheletrici. Quando in un quadro di AIG vi è anche interessamento dell'articolazione coxo-femorale, l'antiversione femorale aumenta: a ciò conseguono un'intratorsione femorale e una lateralizzazione della rotula. Se a questo quadro aggiungiamo altre deformità e alterazioni possibili in un quadro di AIG (extrarotazione ed extratorsione tibiale, displasia trocl...

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Cemented Total Knee Arthroplasty in Patients with Juvenile Rheumatoid Arthritis

Cited by 16 publications

References 15 publications

Quality of Life After TKA for Patients With Juvenile Rheumatoid Arthritis

Quality of Life After TKA for Patients With Juvenile Rheumatoid Arthritis

Juvenile idiopathic arthritis in adulthood and orthopaedic intervention

La femoro-rotulea nell’artrite idiopatica giovanile

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