Joint Replacement for Juvenile Idiopathic Arthritis

When you hear about joint replacement surgery, you probably think it's something that older folks need. But kids with juvenile idiopathic arthritis (JIA), who have painful, stiff joints, might get relief, too.

When medicine and other treatments haven't worked, joint replacement can offer dramatic benefits. The catch is that it's an uncommon operation in kids. It's complicated and has some real drawbacks.

Who Needs Joint Replacement?

Thanks to better treatment these days, most kids with JIA, which used to be called juvenile rheumatoid arthritis, never need surgery. They're able to control the condition with medications.

Doctors may consider joint replacement surgery as a last resort for children with "end stage" arthritis. That's when the cartilage in a joint, which is like a cushion between the bones, wears away and the bones rub against each other.

Kids in that situation may have constant pain, stiffness, and joint damage that make it hard to do everyday things. Some struggle to walk or can't walk at all.

While JIA can affect joints anywhere in your child's body, most joint replacement surgeries are in the hips and knees. Doctors sometimes replace the shoulder, elbow, and wrist joints, too.

Pros and Cons

While joint replacement may not bring your child back to where she was before she had JIA, it can ease her regular pain. If she needed a wheelchair, she might be able to get around without it.

But the operation does have downsides:

Growth problems. Doctors try to wait until a child has stopped growing before performing joint replacement surgery, since growth can affect the way a new joint fits the patient.

Infections and other issues. Like any operation, joint replacement can lead to an infection, which may need more surgery to cure. Other risks include:

  • Broken bones (during or after surgery)
  • Nerve damage
  • Buildup of scar tissue

Artificial joint breaks down. Studies show that replacement hip and knee joints in kids with JIA often last 10 to 15 years or longer. But they can fail sooner than that. If that happens, your kid will need another operation to fix it.

Joint replacement surgery in children is a challenge for surgeons, too:

  • It's harder than with adults because children's bones are smaller and thinner.
  • Replacement joints are designed for adults, not kids.
  • The operations haven't been well studied, so doctors don't agree on who needs them and how to do them.

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What to Expect

You'll probably have a team of experts who work together, including a rheumatologist and a surgeon. Your child will need tests like CT scans to check her bones and decide on the best approach.

The team may suggest your child take a break from some JIA medications before surgery, since drugs like corticosteroids and anti-TNF agents can raise the risk of infection.

During the operation, the surgeon removes your child's damaged joint and cleans out the area. Then he'll swap in a new one made of plastic, metal, or ceramic.

If your child has serious damage in more than one joint, she may need a few replacements. If that's the case, the team will decide which joint to work on first. For example, if your child needs new hips and knees, the surgeon will probably replace the hip first. That's because rehab with an artificial knee will be harder if her hip still hurts.

After the Operation

Once you're home, follow the doctor's instructions on how to take care of your child and prevent infection. She'll start physical therapy quickly, which will help her get stronger.

Keep in mind that the surgery won't cure JIA. Your child will still need regular checkups, and probably medicine, to keep it under control.

How to Decide

Should your child get the surgery? It's a big decision. While it can have many benefits, some experts don't recommend it because of the risks. It's a tricky operation, so you want a surgeon who has done the exact same kind of surgery before. A second opinion is a good idea as well.

When you meet with rheumatologists and surgeons, make sure to ask lots of questions. The answers will help you make a decision. For example:

  • Is joint replacement a good idea for my child? If so, why?
  • How many joint replacement surgeries in children have you done?
  • How many joints do you think need to be replaced?
  • What are the benefits? Will my child be pain-free?
  • Will this surgery affect my child's growth?
  • When will my child be completely recovered after the operation?
  • How long will the new joint last? Will my child need more surgery in the future?
WebMD Medical Reference Reviewed by David Zelman, MD on March 03, 2020

Sources

SOURCES:

Mayo Clinic: "Juvenile idiopathic arthritis."

Kids Get Arthritis Too (Arthritis Foundation): "When Surgery is Necessary for Your Child."

Medscape: "Juvenile Idiopathic Arthritis Treatment & Management."

OrthoInfo (AAOS): "Juvenile Arthritis."

Arthroplasty Today: "Adolescent total knee arthroplasty."

Cleveland Clinic: "Juvenile Idiopathic Arthritis."

FamilyDoctor.org (American Academy of Family Physicians): "Juvenile Rheumatoid Arthritis."

UpToDate: "UpToDate: Psoriatic juvenile idiopathic arthritis: Treatment," "Polyarticular juvenile idiopathic arthritis: Clinical manifestations, diagnosis, and complications."

Clinical Orthopaedics and Related Research: "Total Knee Arthroplasty in Patients With Juvenile Idiopathic Arthritis."

Hospital for Special Surgery: "Conservative Management of Osteoarthritis," "Multi-Center Study Looks at Longevity of Total Knee Replacements in Younger Patients with Juvenile Arthritis."

Orthopedic Clinics of North America: "Surgical Management of the Juvenile Idiopathic Arthritis Patient with Multiple Joint Involvement."

The Archives of Bone and Joint Surgery: "Hip Arthroplasty and its Revision in a Child: Case Report and Literature Review."

Arthritis Foundation: "Juvenile Idiopathic Arthritis Treatment."

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