Revision total hip arthroplasty in juvenile chronic arthritis: 17 revisions in 11 patients followed for 4-12 years.
BACKGROUND
Revision total hip arthroplasty (THA) in patients with juvenile chronic arthritis (JCA) is complicated by the young age of the patient, poor bone stock and small physical proportions. We report the complications and outcome of a prospective series of 17 revision THAs in Charnley class C JCA patients.


METHODS
15 acetabular components and 10 femoral components were revised. 13 cementless cups, 2 reconstruction/roof rings and cemented cups, and 4 cemented and 6 cementless femoral stems were implanted. 2 proximal femoral allografts and 1 strut allograft were used. Age at revision was 32 (21-53) years. Follow-up averaged 7 (4-12) years.


RESULTS
2 patients with cemented femoral stems developed loosening, osteolysis and fracture. Both were successfully revised to long-stem cementless implants with strut/proximal femoral allografts. 1 loose, worn cementless cup with osteolysis was revised. 1 patient with a peri-operative infection and late acetabular fracture had a loose, non-revised cementless cup. 1 case of sciatic nerve palsy occurred after revision using a reconstruction ring. 1 late infection necessitated resection arthroplasty. Harris hip scores improved from 53 (34-85) to 76 (47-96).


CONCLUSIONS
Revision THA in JCA has a substantial complication rate, even in experienced hands. The problem of obtaining long-term stable fixation, osteolysis, and replenishment of lost bone stock are major difficulties.
Goodman
Stuart B
SB
Department of Orthopaedic Surgery, Stanford University School of Medicine. Stanford, California, USA. goodbone@stanford.edu
Oh
Kwang-Jun
KJ
Imrie
Susanna
S
Hwang
Katherine
K
Shegog
Mychelle
M
D000293:Adolescent; D000328:Adult; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016025:Bone Transplantation; D002484:Cementation; D002648:Child; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome