Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2737-2748. doi: 10.1007/s00590-023-03525-x. Epub 2023 Mar 22.
The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16-150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA.
Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included.
The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10-33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8-25%) as compared to 4% (95% CI 1-6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared.
JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival.
IV.
全世界儿童中，幼年特发性关节炎（JIA）的患病率估计为每 10 万人中有 16-150 人。超过 50%的儿童髋关节受累，导致发病率显著升高，可能需要通过关节成形术进行手术干预。文献缺乏对幼年特发性关节炎（JIA）全髋关节置换术（THA）的结果，包括并发症和植入物存活率的简明概述。本研究的目的是系统地分析文献并报告 JIA 中 THA 的结果。
在在线数据库 PubMed、Embase 和 Cochrane 数据库中进行了搜索。纳入了所有评估 JIA 患者 THA 临床和/或放射学结果的原始研究，样本量至少为 5 例，且以英文发表。根据牛津循证医学中心的标准对纳入研究的证据水平进行分级。使用卫生经济学研究所清单评估纳入研究的质量。
纳入的 9 项研究均为回顾性研究，根据牛津循证医学中心的标准，均为 IV 级。本综述纳入了 304 名患者中的 475 髋，其中大多数为女性（241/304，79.2%）。所有研究均使用各种评分客观地报告了结果。需要翻修手术（92/378，股骨或髋臼）的比例为 22%（95%CI 10-33%）。髋臼翻修的比例为 16%（95%CI 8-25%），而股骨翻修的比例为 4%（95%CI 1-6%）（20/378）。比较骨水泥固定和非骨水泥固定植入物时，生存率无差异。
患有晚期髋关节疾病的 JIA 患者是一个特殊人群，需要更长的植入物寿命。JIA 患者的 THA 可改善疼痛缓解和活动能力，但相同结果转化为功能性活动的比例并未相应提高。目前的趋势是使用非骨水泥和陶瓷对陶瓷植入物。与股骨植入物相比，髋臼植入物需要更早翻修。早期使用甲氨蝶呤可以延迟手术年龄，从而间接提高植入物的存活率。
IV。
