Considerations for total joint replacement due to juvenile rheumatoid arthritis

If your child has severe joint damage from juvenile rheumatoid arthritis (JRA), your child's doctors may recommend a total joint replacement. As you and the doctors work through this decision together, consider the following:

• Your child's age. Consider how old your child is: His or her bones may still have a lot of growing to do. The decision to have surgery depends on the size and quality of your child's bones, the size of the joint replacement parts, the health of the tissues around the joint, and how likely it is that your child will be able to follow a rehabilitation program.
• Amount of growth remaining. Young children who still have significant bone growth remaining may lose some of their growth potential in height and size if total joint replacement affects nearby growth areas in the bones.
• Size of the bones. Older children have larger bones, which are easier to fit with total joint replacement parts. Even when total joint replacement is delayed, many children need custom-fit knee replacement parts.
• Other joint involvement. It is easier to predict the success of total joint replacement if only one joint, such as the knee joint, is involved and all other joints in that limb are normal. This is often not the case in children who need total joint replacement. Other joint abnormalities may make the surgical procedure more difficult or complicate the recovery process. For example, a child with an affected knee and hip in the same leg may have a difficult rehabilitation from total hip replacement if the knee is painful and stiff.
• Ability to use walking aids. If a child's upper extremities (such as the elbow and shoulder) are affected by arthritis, it may be hard for him or her to use crutches or walkers during the rehab process following a total hip replacement.
• How long will the joint replacement last? Depending on how old a child is when diagnosed with JRA, he or she can expect to live for another 50 to 80 years. Many joint replacements must be redone after 10 to 30 years of use because the parts loosen. Most children with JRA do not put the same amount of stress on a total joint replacement as active or athletic adults who have had replacements for osteoarthritis, but loosening still occurs eventually. A very young child may need another joint replacement by age 20 and might need to replace the same joint 3 or 4 times over a lifetime.
• Anesthesia. Children with JRA require neck X-rays before they have any procedure that uses general anesthesia. General anesthesia causes the muscles of the neck to relax. This can increase the risk of spinal cord injury in children whose neck joints are affected by JRA. It is recommended that the child wear a soft neck collar to the operating room to remind the surgical team of the potential for cervical (neck) spine problems.