Abstract
Juvenile idiopathic arthritis (JIA) affecting the hip can cause debilitating pain and walking disability in children. Total hip replacement offers the potential of a pain free joint and a significant improvement in function. There remains the concern regarding the high rates of aseptic loosening of cemented total hip replacements in this group of patients, and there is evidence that younger patients have higher failure rates.
The aim of this study was to look at the results of uncemented total hip replacement in children with Juvenile Idiopathic Arthritis and in particular to assess any problems associated with performing this surgery in the presence of open growth plates in the acetabular and trochanteric regions.
Between 1995 and 2005, 56 uncemented total hip replacements were carried out in 37 children with JIA with a mean follow up of 7.5 years (range 3 to 12.5). 25 of the hips had ceramic on ceramic bearings. The mean age at surgery was 13.9 years (range 11–16). 19 patients underwent bilateral procedures. All patients showed a significant improvement in their HSS Hip scores (p< 0.01). Two CAD CAM femoral stems were revised for gross subsidence and three acetabular components were revised for loosening. Four polyethylene liners were exchanged due to wear. 51 of 53 (96%) femoral stems and 50 (94%) acetabular components remain well fixed at latest follow up with no signs of loosening. There were no dislocations or infections.
Uncemented fixation appears to work well in this challenging group of patients even in the presence of open growth plates. Implant choice is important to avoid problems of subsidence and loosening. Ceramic bearings available for small implant sizes give promise of improved performance compared to polyethylene over the long term.
Correspondence should be addressed to Editorial Secretary Mr ML Costa or Assistant Editorial Secretary Mr B.J. Ollivere at BOA, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England; Email: mattcosta@hotmail.com or ben@ollivere.co.uk
