title: Total knee arthroplasty in patients with juvenile idiopathic arthritis.
abstract: BACKGROUND
  Total knee arthroplasty (TKA) for juvenile idiopathic arthritis is rare but is nonetheless indicated for many patients with this disease. Few reports exist on the results of TKA in patients with juvenile idiopathic arthritis.
  
  
  OBJECTIVE
  It was sought to determine (1) survivorship and (2) functional outcomes of TKAs in patients with juvenile idiopathic arthritis.
  
  
  METHODS
  Results were combined from patients treated by experienced surgeons at five hospitals between 1979 and 2011. Two hundred nineteen patients (349 TKAs) were identified and contacted to survey their outcomes at a minimum followup of 2 years (mean, 12 ± 8 years; range, 2-33 years). The average age at surgery was 28.9 ± 9.7 years (range, 11-58 years). Data on revision surgery and ability to perform daily activities were collected.
  
  
  RESULTS
  The 10-year survivorship was 95%, decreasing to 82% by 20 years. At latest followup, 31 of 349 TKAs (8.9%) had been revised for either polyethylene failure or loosening (18 TKAs), infection (four), stiffness (three), periprosthetic fractures (two), bilateral amputation for vascular reasons (two), patellar resurfacing (one), and instability (one). Walking tolerance was unlimited in 49%, five to 10 blocks in 23%, and less than five blocks in 28%. Eleven percent could not manage stairs, and another 59% depended on railings. A cane was used by 12% and crutches by 7%; 12% were wheelchair-dependent.
  
  
  CONCLUSIONS
  TKA survivorship in patients with juvenile idiopathic arthritis was inferior to that typically seen in younger patients with osteoarthritis or even rheumatoid arthritis confirming results of earlier studies with smaller patient numbers. This is especially disconcerting because younger patients require better durability of their TKAs.
authors.affiliation: University Hospital Marburg, Marburg, Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Heyse
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ries
authors.forename: Johan
authors.initials: J
authors.lastname: Bellemans
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Goodman
authors.forename: Richard D
authors.initials: RD
authors.lastname: Scott
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Wright
authors.forename: Jospeh D
authors.initials: JD
authors.lastname: Lipman
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
authors.forename: Mark P
authors.initials: MP
authors.lastname: Figgie
mesh_terms: D000293:Adolescent; D000328:Adult; D001171:Arthritis, Juvenile / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee; D002648:Child; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016896:Treatment Outcome