Primary Total Hip Arthroplasty in Juvenile Idiopathic Arthritis: Survivorship After a Median Follow-Up of 12 Years

Shay I Warren; Katherine L Hwang; Jonathan J Lee; Adam J Murrietta; Jayme C B Koltsov; Stuart B Goodman

doi:10.1016/j.arth.2023.12.021

Primary Total Hip Arthroplasty in Juvenile Idiopathic Arthritis: Survivorship After a Median Follow-Up of 12 Years

J Arthroplasty. 2023 Dec 15:S0883-5403(23)01213-5. doi: 10.1016/j.arth.2023.12.021. Online ahead of print.

Authors

Shay I Warren¹, Katherine L Hwang¹, Jonathan J Lee¹, Adam J Murrietta¹, Jayme C B Koltsov¹, Stuart B Goodman¹

Affiliation

¹ Department of Orthopaedic Surgery, Stanford University, Redwood City, California.

PMID: 38104785
DOI: 10.1016/j.arth.2023.12.021

Abstract

Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition of childhood that frequently affects the hip. Total hip arthroplasty (THA) in JIA can be challenging due to the patient's young age, small proportion, complex anatomy, and bone loss. Outcome data are limited.

Methods: We reviewed prospectively collected data in 57 JIA patients (83 hips) who underwent THA between 1986 and 2020 by a single surgeon. The median patient age at surgery was 26 years (range, 14 to 62). Reoperation-free survival was assessed via the cumulative incidence function, accounting for the competing risk of death. Relationships between patient and implant factors and survivorship were evaluated by stratification of the cumulative incidence function and Gray's tests. Wilcoxon signed rank tests were used to assess the preoperative to latest postoperative change in patient-reported outcome measures.

Results: At a median (interquartile range) of 12 (4, 20) years of follow-up, 13 (16%) patients underwent reoperation, most commonly for polyethylene wear and osteolysis (7 hips). The estimated incidence of 10-year, 20-year, and 30-year revision (95% confidence interval) were 11.3% (4.5, 21.6%), 18.5% (8.9, 30.9%), and 40.6% (19.4, 60.9%), respectively. There were no differences in survival based on patient age, sex, implant fixation method, polyethylene type, or thickness. All patient-reported outcome measures improved from preoperative to latest follow-up.

Conclusions: Primary THA is a durable and effective treatment for JIA patients with severe hip involvement and results in major improvements in pain and function. We did not identify any factors predictive of failure.

Keywords: clinical outcomes; complications; juvenile idiopathic arthritis; survival analysis; total hip arthroplasty.