Radiological loosening after cemented hip replacement for juvenile chronic arthritis

Learmonth, Ian D.; Heywood, A. W. B.; Kaye, Jeremy J.; Dall, Desmond M.

doi:10.1302/0301-620x.71b2.2925736

Cited by 60 publications

(32 citation statements)

References 10 publications

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“…Elsewhere it has been postulated that epiphyseal growth occurs by endo-cartilagenous ossification and at the diaphysis it occurs by radial expansion. 32 The authors suggested the high rate of loosening in young patients resulted from the bone surrounding the implant growing away from it. Osteopenia due to steroid use, disease and poor nutrition, as well as joint contractures altering the magnitude and direction of forces borne by the implant, have also been implicated in the high rates of loosening.…”

Section: Discussionmentioning

confidence: 99%

The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years

Daurka

Malik

Robin

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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The inherent challenges of total hip replacement (THR) in children include the choice of implant for the often atypical anatomical morphology, its fixation to an immature growing skeleton and the bearing surface employed to achieve a successful long-term result. We report the medium-term results of 52 consecutive uncemented THRs undertaken in 35 paediatric patients with juvenile idiopathic arthritis. The mean age at the time of surgery was 14.4 years (10 to 16). The median follow-up was 10.5 years (6 to 15). During the study period 13 THRs underwent revision surgery. With revision as an endpoint, subgroup analysis revealed 100% survival of the 23 ceramic-on-ceramic THRs and 55% (16 of 29) of the metal- or ceramic-on-polyethylene. This resulted in 94% (95% CI 77.8 to 98.4) survivorship of the femoral component and 62% (95% CI 41.0 to 78.0) of the acetabular component. Revision of the acetabular component for wear and osteolysis were the most common reasons for failure accounting for 11 of the 13 revisions. The success seen in patients with a ceramic-on-ceramic articulation seems to indicate that this implant strategy has the potential to make a major difference to the long-term outcome in this difficult group of patients.

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Section: Discussionmentioning

confidence: 99%

The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years

Daurka

Malik

Robin

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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show abstract

“…Historically, very young patients (defined as those 30 years of age and younger [4]) have not experienced the same survivorship as their older counterparts. This has been attributed to an antiquated surgical technique and the use of THA in patients with juvenile rheumatoid arthritis [5,6,14,22,23,26]. However, it is unclear whether young patients have benefitted from improving outcomes afforded by contemporary THA.…”

Section: Introductionmentioning

confidence: 99%

Has Total Hip Arthroplasty in Patients 30 Years or Younger Improved? A Systematic Review

Adelani

Keeney

Palisch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

117

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“…Primary cemented THA in JIA has demonstrated in other reports an aseptic loosening rate of 19% to 57% at 5 to 10 years followup [4,23,27,38]. The survivorship of cementless primary THA in patients with JIA was reported to be 96% to 100% for the femoral stem and 88% to 90% for the acetabular cup at 5 to 13 years followup [20,21,30].…”

Section: Discussionmentioning

confidence: 95%

High Complication Rate in Revision Total Hip Arthroplasty in Juvenile Idiopathic Arthritis

Goodman¹,

Hwang²,

Imrie³

2013

Clin Orthop Relat Res

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Background Revision total hip arthroplasty (THA) in patients with juvenile idiopathic arthritis (JIA) is challenging as a result of the patient's young age, systemic disease, multiple affected joints, small proportions, and bone loss. The intermediate-to long-term results of these surgeries remain unknown. Questions/purposes The purpose of this study is to determine the (1) functional outcomes; (2) surgical complications; and (3) frequency of reoperation or revision after revision THA for JIA. Methods We reviewed the records of all patients from one center who underwent revision THA for JIA who had a minimum of 5 years of followup (mean, 9 years; range, 5-19 years). This resulted in a series of 24 revision THAs in 15 patients. All patients were Charnley Class C. Age at revision averaged 35 years (range, 21-53 years). The 20 acetabular and 12 femoral revision components included 15 cementless cups, five reconstruction/roof rings with a cemented cup, and four cemented and eight cementless femoral stems. Results The Harris hip scores improved from 54 (range, 34-85) to 77 (range, 37-100) (p \ 0.001). Complications included two proximal femoral fractures associated with severe osteolysis and one sciatic nerve palsy in a patient with severe acetabular deficiency. A total of seven hips (29%) required reoperation or revision surgery, including three for infection (one early and two late) and four for mechanical loosening. Conclusions Revision THA in JIA is very challenging owing to patients' small proportions and compromised bone stock. The intraoperative and early complication rates are relatively high. Prognosis for long-term survivorship is guarded; limiting factors include periprosthetic osteolysis associated with older implants that used conventional polyethylene and cemented stems.

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Radiological loosening after cemented hip replacement for juvenile chronic arthritis

Cited by 60 publications

References 10 publications

The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years

The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years

Has Total Hip Arthroplasty in Patients 30 Years or Younger Improved? A Systematic Review

High Complication Rate in Revision Total Hip Arthroplasty in Juvenile Idiopathic Arthritis

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