title: Results of bilateral combined hip and knee arthroplasty in very young patients with juvenile rheumatoid arthritis.
abstract: BACKGROUND
  We evaluated the long-term outcomes for combined, bilateral total knee and hip arthroplasty performed on a group of very young patients with juvenile rheumatoid arthritis.
  
  
  METHODS
  Six consecutive patients with a mean age of 14 years at the time of hip replacement and 16 years at knee replacement were analyzed. Five of the six patients were wheelchair dependent pre-operatively. All knee components had uncemented fixation, while the hip replacements were a mixed group of cemented and uncemented prostheses.
  
  
  RESULTS
  Clinical and radiographic follow-up at a mean duration of 13.8 years for the hips and 17.3 years for the knees demonstrated four of the six patients were unlimited community ambulators, one a limited community ambulator and the remaining patient a household ambulator. Failure, defined as revision of any of the components or definite radiographic loosening, occurred in three knees (two patients) and five hips (three patients).
  
  
  CONCLUSIONS
  These good long-term functional results in a relatively very young population indicate that an early and aggressive approach to multiple joint disease is an appropriate option at a young age for patients with juvenile rheumatoid arthritis with severe disability and pain refractory to conservative management.
authors.affiliation: Department of Orthopaedic Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. kjm@indigo.ie
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Mulhall
authors.forename: Khaled J
authors.initials: KJ
authors.lastname: Saleh
authors.forename: Corey A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Erik P
authors.initials: EP
authors.lastname: Severson
authors.forename: David H
authors.initials: DH
authors.lastname: Palmer
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000503:physiopathology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome