JOA - 2026-06-01 - Journal Article
Revision Total Hip Arthroplasty in Juvenile Idiopathic Arthritis: Survivorship After a Mean Follow-Up of 11 Years.
Tantikosol P, Hwang K, Pham NS, Goodman SB
Topics
Key Takeaway
Revision THA in JIA patients yields only 36% reoperation-free survival at 10 years, with a 41.2% overall complication rate.
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Summary
This single-surgeon retrospective study evaluated reoperation-free survival and complications in 34 hips (24 JIA patients) undergoing revision THA over a 24-year period. Kaplan-Meier analysis demonstrated 54% reoperation-free survival at 5 years and 36% at 10 years. Complications occurred in 41.2% of cases, including infection, nerve palsy, and dislocation; longer hospital stay was associated with reduced reoperation-free survival (HR 0.15, 95% CI 0.03–0.72, p=0.018).
Key Limitation
The extremely wide 95% confidence intervals (10-year survival: 17–80%) from a 34-hip single-surgeon series preclude reliable estimation of true survivorship or identification of independent risk factors.
Original Abstract
BACKGROUND
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition that often affects the hip joints during childhood. Due to the high incidence of failure of initial total hip arthroplasty (THA) performed years earlier for JIA, revision surgeries are frequently necessary and particularly challenging. This study evaluated the outcomes of these complex revision procedures after an average follow-up of 11 years (range, 26 to 284 months).
METHODS
A retrospective review of 24 patients (34 hips) who had JIA undergoing revision THA between January 1999 and December 2023 was conducted. The mean age of the cohort was 40 years (range, 17 to 61), with an equal number of men and women patients. All surgeries were performed by a single surgeon. Data sources included clinical records and surgical reports. Univariate analyses were performed using Mann-Whitney tests for continuous variables and Chi-square/Fisher's exact tests for categorical variables. Kaplan-Meier survival curves were generated to estimate reoperation-free survival.
RESULTS
The Kaplan-Meier survival analysis showed reoperation-free survival rates of 54% at 5 years and 36% at 10 years. The 95% CIs (confidence intervals) for these estimates were 31 to 93% and 17 to 80%, respectively. Univariate analyses revealed a notable association between complications and length of hospital stay (hazard ratio [HR]: 0.15; 95% CI: 0.03 to 0.72; P = 0.018). A total of 41.2% of patients experienced complications such as infection, nerve palsy, and dislocation.
CONCLUSIONS
Revision THA in patients who had JIA is associated with a high complication rate and reduced reoperation-free survival. Early identification of risk factors, meticulous surgical planning, and comprehensive postoperative care are critical to improving long-term outcomes.