Young Patients

Currently, the three most common joint replacement surgeries are hip, knee, and shoulder. Arthrosis and arthritis are usually the main causes for the different types of arthroplasty. Although the majority of patients undergoing arthroplastic surgery are over 65 years of age and are affected by different types of arthritis, essentially osteoarthritis and rheumatoid arthritis, it is currently convenient to study its use in young patients whose evaluation, in terms of synthesis of evidence, presents considerable limitations.

In the advance of the heterogeneous set of orthoprosthetic techniques and procedures, joint replacement surgery occupies a cardinal place. It is designed to replace damaged cartilage and any associated loss of bone structure. The clinical spectrum of its indication is very broad and the procedure itself is a reconstruction of the damaged joint, which relies on the patient's muscles and ligaments to provide support and function. However, it is not a homogeneous procedure at all. The prosthesis can be made of titanium, cobalt chromium, stainless steel, ceramic material or polyethylene (plastic) and can also be fixed to the bone with acrylic cement or with a forced fit.

In the specialized literature it is collected that in young people, specifically, the following pathologies have been found that require joint replacement: benign fibrous histiocytoma, trauma, septic arthritis of the hip, juvenile rheumatoid arthritis, traumatic lesions, among others.

Considering that juvenile rheumatoid arthritis (JRA), inflammatory arthropathy of autoimmune origin and chronic course, is the first cause of chronic arthritis in childhood, and that traumatic injuries that damage joint structures, are some of the reasons why currently a greater number of patients at early ages resort to joint replacement surgery, it is of interest their approach. In particular, it has been possible to appreciate that the proliferation and dispersion of these subjects in the bibliography makes it difficult for researchers, firstly, to identify the causes that favor that currently a growing number of young people need this type of surgery and, secondly, to value the expectations of success in the results of joint replacement surgery in these patients.

A study conducted in Argentina in 2008 states that professional or amateur sports practice and sustained physical activity of any kind are the main factors in the need for joint replacement surgery in young patients. Another carried out in Ecuador in 2013 highlights the high incidence of fractures of long bones in children and traffic accidents both in cars and motorcycles, plus falls from great heights and bullet wounds, which cause spinal trauma.

Another of the main causes according to Lara, Tobar and Moya, after an investigation carried out in Chile in 2014, is related to the subjection of the prosthetic components to much greater load cycles, with bone and muscle morphological alterations, in several cases with osteotomies and bone grafts, which condition the success of the surgery.

Similarly, the traumatic knee with destruction of the joint can be corrected by total knee replacement, as shown in another study conducted in Guatemala in 2014. On the other hand, rheumatoid arthritis and traumatic sequelae can lead to the use of knee implants considered unicompartmental in young people, usually reserved for cases over 65 years of age, as shown in a study dated in Chile in 2012.