Total Knee Arthroplasty in Juvenile Rheumatoid Arthritis

Abstract

Good results, in terms of pain relief and restoration of function, were seen at a minimum of twelve years following total knee arthroplasty in our series of patients with juvenile rheumatoid arthritis. This procedure is a reasonable option when nonoperative therapy has been inadequate for patients with severe disability and pain in this relatively young population.

Quality of Life After TKA for Patients With Juvenile Rheumatoid Arthritis

“…Benefits of TKA in patients with JRA have been documented [4,7,8,26,29], but our study quantifies satisfaction and quality of life after TKA in different domains of daily life. 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.…”

“…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.…”

“…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.…”

“…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].…”

Epidemiology of adolescent total knee arthroplasty patient and a comparison to adult patient demographics

“…[1][2][3][4][5] Although TKA is typically performed on adult patients, it is also utilized to treat pediatric diseases affecting the knee joint such as childhood osteosarcoma, advanced juvenile rheumatoid arthritis (JRA), and osteoarthritis. [6][7][8][9][10][11][12] Despite high rates of complications and increased likelihood of revision in the younger population, the procedure has high success rates in providing pain relief, increasing joint function and improving quality of life for those who suffer from degenerative knee disorders. [9,[13][14][15][16] The incidence of primary TKA in the US population has increased between 1990 and 2002 from 129,000 to 381,000.…”