Total joint replacement in childhood arthritis

Abstract

Juvenile rheumatoid arthritis poses a distinct challenge to pediatric rheumatologists and orthopedic surgeons. Recent developments in the medical management of juvenile rheumatoid arthritis have decreased the need for surgical intervention in this subset of patients; however, those patients who need surgery are often the most challenging cases due to their relatively small bone size, the complex deformity caused by soft tissue contractures, and the tendency for multiple joint involvement. Nonetheless, technologic improvements in implant design and surgical techniques have led to successful outcomes in otherwise debilitating conditions. A careful and coordinated approach to the surgical management of juvenile rheumatoid arthritis can lead to improved function and significant pain relief for children with rheumatoid arthritis.

Review of the Pathophysiology, Diagnosis, and Orthopedic Treatment Options for Juvenile Idiopathic Arthritis

“…The International League of Associations for Rheumatology (ILAR) compiled new nomenclature, definitions, and diagnostic criteria to replace the previous classification of "Juvenile Rheumatoid Arthritis." The current definition of JIA is a diagnosis of exclusion encompassing a group of disease subtypes that can be characterized by the onset of arthritis before the age of 16 and symptoms lasting 6 weeks [15]. The diseases are categorized into seven subtype groups: systemic arthritis, oligoarthritis (persistent or extended), polyarthritis rheumatoid factor (RF)-positive, polyarthritis RF-negative, enthesitis-related arthritis (ERA), psoriatic arthritis (PsA), and undifferentiated arthritis [16].…”

“…Orthopedic surgical treatment is often necessary for correcting deformity, limb length discrepancy, or severe arthritis [2]. Operative methods include releasing of soft tissues, osteotomies, synovectomies, total joint replacements, and joint fusions [2,15,21]. Complex joint deformity caused by soft tissue contracture may complicate and decrease functionality.…”

“…In the shoulder and hip joint, extensive soft tissue release may be adequate for deformity correction. However, in the knee joint, soft tissue release often requires adjunct bony resection [15]. Total hip and knee replacement is often indicated for joint destruction, functional impairment, deformity, or severe pain [26].…”

Endoprothetik bei Erwachsenen mit juveniler idiopathischer Arthritis

“…Anders bei der Hüft-und Knieendoprothetik: Hier existieren zahlreiche Studien, die insbesondere einen Anstieg der Le-bensqualität mit Schmerzreduktion und Verbesserung der Beweglichkeit und Belastungsfähigkeit der unteren Extremitäten beweisen (4,5,7,15,16).…”

Schultergelenkersatz beim juvenilen Rheumatiker

“…Der Schultergelenksbefall bei der juvenilen idiopathischen Arthritis (JIA) ist in mindestens 50 % der Verläufe zu erwarten (1,5,9,16). Schmerz und Bewegungseinschränkung treten erst im weiteren Verlauf auf und spielen zu Beginn meist eine untergeordnete Rolle.…”