Background: There is a paucity of reports regarding the long-term
results of total knee arthroplasty in patients with juvenile rheumatoid
arthritis. The purpose of this study was to evaluate the outcome of total knee
arthroplasty in patients with juvenile rheumatoid arthritis who had been
followed for a minimum of twelve years.
Methods: Eight consecutive patients (fifteen knees) with juvenile
rheumatoid arthritis underwent total knee arthroplasty at an average age of
16.8 years. Clinical evaluation of pain status, range of motion, and the
ability to walk and radiographic evaluation of the alignment of the knees and
component loosening were performed preoperatively and at a mean of 15.5 years
Results: All patients had substantial pain and functional limitation
before the surgery, and seven of the eight patients used a wheelchair. At the
time of the latest follow-up, which was after revision surgery in three
patients, all of the knees were pain-free and six patients were able to walk
about the community. The mean arc of motion had increased from 36° to
79°. The final radiographic evaluation showed that thirteen of the fifteen
knees were in neutral alignment and two were in valgus. Failure, defined as
revision of any of the components or definite loosening as seen
radiographically, occurred in three knees.
Conclusions: Good results, in terms of pain relief and restoration
of function, were seen at a minimum of twelve years following total knee
arthroplasty in our series of patients with juvenile rheumatoid arthritis.
This procedure is a reasonable option when nonoperative therapy has been
inadequate for patients with severe disability and pain in this relatively
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.