Total Knee Replacement at HSS in Subjects under 35 Years of Age: A Retrospective Chart Review

Mentor

Mark Figgie, MD

Scope

Juvenile rheumatoid arthritis (JRA) is a serious and painfully debilitating condition that impacts more than 50,000 children in the United States. The most frequently affected site in JRA is the knee joint, which is involved in two thirds of patients at disease onset. On clinical presentation, the investigator has observed that patients with JRA frequently have increased blood flow to their joints as a result of their disease and may develop overgrowth followed by early growth plate closure. These patients frequently have a trumpet shaped distal femur with a mismatch between the medial-lateral and anterior-posterior dimensions. In addition, they often present with external rotation deformities of their proximal tibia, valgus deformities, and flexion contractures. In sum, over time, JRA leads to destruction of the knee joint in this vulnerable patient population.

Total knee arthroplasty (TKA) is often indicated in patients with juvenile rheumatoid arthritis when there is marked functional impairment, severe disabling pain from advanced structural knee joint involvement, or when marked joint destruction is present and pain or deformity compromises function. In addition to JRA, other (less documented) indications for TKA in the pediatric population include hemophilia, skeletal dysplasia, lupus and traumatic arthritis. A broad clinical experience has led this investigator to believe that, in addition to these conditions and JRA, there may be yet other indications for joint replacement in this younger population (that, while lower in incidence, may represent a significant and particularly vulnerable pediatric population). Therefore, in an effort to maximize the treatment protocols for all pediatric patients undergoing TKA, it is important to identify all indications for which surgical intervention is deemed necessary.

Once the indications have been determined, the pathoanatomy of each of these conditions will be evaluated and documented. The investigator and a research nurse will review the charts and radiographs of all total knee arthroplasties in patients between the ages of 5 and 35 years of age for all indications including but not limited to JRA, lupus, hemophilia, and skeletal dysplasia. The goal of this first step is to identify all severely affected pediatric patient populations for whom total knee arthroplasty is a treatment option. Medical records of appropriate surgeries dating back to 1985 will be reviewed.

This retrospective chart review is the first step in what may lead to:

1. a prospective study of these juvenile patient populations undergoing total knee arthroplasty for a range of indications including the most prominent, JRA
2. the design of a knee prosthesis better suited to the unique anatomic features of this younger population
3. earlier surgical intervention to avoid a lapse in mobility, diminished capacity for activities of daily living, and overall poorer quality of life

The inclusion criteria are male and female patients between 5 and 35 years of age who have undergone or are undergoing total knee replacement at HSS. Subjects will be identified from the medical records data base. In addition, the investigator maintains a database of all of his surgical cases. He roughly estimates that after a review of the medical records, approximately 100 subjects will be identified.

Contact

Mark Figgie, MD
email: figgiem@hss.edu