Delays in Joint Replacement as JIA Patients Reach Adulthood Save

A retrospective cohort study examined the need for joint replacement surgery in juvenile idiopathic arthritis (JIA) and showed there has been a trend to delay arthroplasty over time. The JIA category, year of implant, and presence of complications significantly affected implant survivorship.

This single center, retrospective study included 85 JIA patients (median follow-up period of 17.2 years) who underwent total joint replacement between 1992 and 2019.

Over 27 years, there were 198 replaced joints. The median age at first prosthesis was 22.7 years. Nearly two-thirds of implants involved the hip, with the other one-third mostly knee implants. JIA subtypes included mostly polyarticular JIA and systemic JIA .

Overall, the age at arthroplasty and of disease duration before arthroplasty increased over time, from a mean implant age of 21.93 yrs. before 2000  to 27.81 years after 2010.  During this same period rates of implant survival (at 5, 10, and 15 years) did not change with time. Half of implanted joints lasted ≥20 years.

The JIA category, year of implant, and presence of complications significantly affected implant survivorship. Thus, systemic JIA had lower implant survival rates compared to patients with polyarticular JIA. In multivariate analysis, the year of surgery signicantly impacted to implant survival (HR 1.004;1.0002– 1.0006) as did the presence of complications (HR 3.69; 1.82– 7.48]; P < 0.001). 

Presumeably, progressive improvement of medical treatment over time has lowered the need for total joint replacement as JIA patients reach adulthood.