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TKA in adolescent patients yielded positive outcomes at 10-year follow-up

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Patients who underwent total knee arthroplasty for end-stage arthritis when they were adolescents experienced a 95% implant survivorship at 10-year follow-up, according to results of a registry-based study.

Robert T. Trousdale

“Historically, people … have been hesitant to perform knee arthroplasty in extremely young patients, but if their disease and symptoms are severe enough … historically we would treat those patients with a knee fusion or resection or put them on crutches,” Robert T. Trousdale, MD, professor of orthopedics at Mayo Clinic, told Orthopedics Today. “But this study suggests that, at least a subset of patients, at 5 [years] to 10 years do extremely well with their durability and their function dramatically improved,” said Trousdale, who is an Orthopedics Today Editorial Board Member.

Among 19 patients aged 20 years or younger who underwent TKA between 1979 and 2013, Trousdale and his colleagues found the most common underlying diagnosis for TKA was juvenile idiopathic arthritis. The next most common diagnoses were avascular necrosis, septic arthritis, post-traumatic arthritis, knee dysplasia and hemophilia.

Results showed an overall revision-free survival of 96% at 5 years and of 94% at 10 years, with the most common reasons for revision surgery being aseptic loosening or polyethylene wear. Over the last several decades, researchers noted there was a decrease in the number of TKAs performed for inflammatory arthritis.

“There is a caveat or caution that these kids are teenagers [who] underwent knee replacement and we still do not have 30-[year], 40-[year], 50-year data, which is important because these kids are going to live 30 [years], 40 [years] and 50 years, realistically,” Trousdale said. “Certainly, early on, our results are favorable, but we certainly do not have long-term data—no one does,” he said.

The fact that the majority of patients had inflammatory arthritis was one study limitation. According to Trousdale, that is because inflammatory arthritis is not normally treated with TKA due to the less-invasive treatments that are available. Future research should involve collecting long-term follow-up on diseases that typically lead to TKA in adolescents, he noted.

“It would be good to take a group of patients that have diseases that in 2018 would need a total knee. In the teenage population that would basically be post-traumatic problems, infection problems or avascular necrosis,” Trousdale said. “… The next step would be to take a group of patients that have those diagnoses, a large group, and follow them for 10 [years], 15 [years], 20 years,” he said. – by Casey Tingle

Martin JR, et al. Arthroplast Today. 2017;doi:10.1016/j.artd.2016.04.002.

Robert T. Trousdale, MD, can be reached at 200 First St. SW, Rochester, MN 55905; email: trousdale.robert@mayo.edu.

Disclosure: Trousdale reports no relevant financial disclosures.