When Your Child With JIA Needs Surgery

While surgery is less common in children with arthritis these days, sometimes it is necessary. Here's what you need to know.

By Mary Anne Dunkin

In the last two decades, the need for surgery for juvenile idiopathic arthritis (JIA) has been dramatically reduced. Thanks to the emergence and more aggressive use of powerful drugs, your child faces a much lower risk of developing joint damage that’s substantial enough to require some type of surgical intervention. “We used to see children with severe joint destruction of multiple joints including both hips and knees, but now we rarely see those patients. The patients we do see typically are older than before and have oligoarticular disease-affecting one or two joints,” observed Mark P. Figgie, MD, chief of the Surgical Arthritis Service at Hospital for Special Surgery (HSS).

By combining medication with other tools – such as regular stretching and exercise to prevent joint contractures, and assistive devices, such as splints, to support or reposition weakened joints -- your child’s joints can be protected for a longer period of time and functioning challenges may be reduced or, ideally, eliminated.
 
Still, surgery sometimes becomes unavoidable, typically for one of two reasons. Either an effective medication regimen couldn’t be identified to stop the progression of joint damage, or your child may have been diagnosed later in the disease process, after significant inflammatory fallout already has occurred. Surgery, in such cases, can provide relief and restore function.

Seeking Surgical Relief
Surgical procedures can provide several potential benefits, including reducing pain and increasing your child’s ability to move and use her joint(s). Depending on the procedure, an orthopedic surgeon may remove inflamed tissue or replace an entire joint.

Procedure by Procedure
The following surgical procedures tend to be the most commonly performed on children with arthritis; the more frequent surgical interventions are ranked closer to the top:

Types of Procedures

Epiphysiodesis

Occasionally arthritis of the knee can cause increased growth or early growth plate closure in the growth centers of the distal femur (the portion of the upper leg bone closest to the knee) and the proximal tibia (the portion of the lower leg bone closest to the knee), resulting in a discrepancy in leg lengths. Epiphysiodesis is an operation that involves surgically closing one of the growth centers of the longer limb, allowing the shorter limb gradually to catch up in length.

Why it’s done: To correct a difference in leg lengths that may be caused by disrupted growth of the limb with arthritis.

What else you need to know: Epiphysiodesis usually is reserved for children whose anticipated leg-length discrepancy is greater than 2 centimeters (or almost an inch) and who have at least two years of growth remaining. The recovery period is brief, and there are few complications

Joint Fusion (arthrodesis)

In this procedure, also called bone fusion, the surgeon removes the cartilage from the ends of two bones that form a joint and then positions the bones together and holds them immobile, often with a pin or a rod. Over time, the two bones fuse to form a single solid unit.

Why it’s done: Arthrodesis can correct joint deformity. It can make the joint more stable, help it bear weight better and relieve pain. It’s most likely to be done on specific joints, including the foot/ankle, hand/wrist and spine.

What else you need to know: Once a joint is fused, your child will not be able to bend it. Fusing one joint can place stress on nearby joints, so major joints including hips and knees are rarely fused

Joint Replacement (arthroplasty)

This surgery involves removing a damaged joint and replacing it with an artificial joint made of metal, ceramics and/or plastics.

Why it’s done: Total joint replacement can often dramatically reduce pain and improve motion, mobility and function. It is usually reserved as the final option for joints that are so severely damaged, painful and stiff that they interfere with the child’s functioning and quality of life. The most commonly replaced joint due to JIA is the hip, followed by the knee; rarely is the ankle, elbow or shoulder replaced.

What else you need to know: Total joint replacement does have some drawbacks. Replacing joints can stunt growth, and the longevity of prosthetic joints is limited. Most doctors delay the surgery as long as possible for young people. Complications can include premature failure of the synthetic joint or an infection that could potentially necessitate additional surgery. Frequently implants need to be custom made for the JIA patient due to bone size and deformity.
 

Synovectomy

This procedure removes excess synovial tissue. The synovium is normally a thin membrane that lines the joint capsule. With chronic inflammation of this lining (as occurs with juvenile arthritis), it not only produces extra fluid, but grows much thicker and can affect joint structure and function. The vast majority of synovectomies are performed by arthroscopy, a procedure in which surgical tools are inserted through a few small incisions, eliminating the need to open the joint.

Why it’s done: Synovectomy is designed to remove excess synovial lining that isn’t responding to treatments, including intra-articular corticosteroid injections. The procedure most often is done on the knee and occasionally the wrist and elbow.

What else you need to know: Although synovectomy can relieve pain and swelling, it doesn’t stop progression of the disease. In most cases, the synovium grows back in a matter of months or years depending on the response to medications. For some children, joint pain and swelling are so severe that surgery is worthwhile for even a short period of relief. If it’s successful, the procedure can be repeated when the synovium grows back.
 
Procedures Performed Less Often Than Children

Osteotomy

Corrects a bone deformity by cutting and repositioning the bone and then resetting it in a better position. By correcting the bone deformities that lead to unusual forces on a joint, and perhaps joint instability and damage, osteotomy also may eliminate or at least delay the need for total joint replacement. The joints it can help include the knee, hip and joints of the foot. Healing takes several weeks and children who have osteotomy to reposition the hip or knee may need total joint replacement later. 

Soft Tissue Release

This procedure involves cutting tissues that have tightened about a joint (contracture), often due to inflammation of the joint lining. Soft tissue release can improve motion and reduce pain and is most effective when joint destruction is not severe. Releases are often required in conjunction with joint replacement. 
 
Stay in the Know. Live in the Yes.

Join the Live Yes! Arthritis Network. Tell us a little about yourself and you will receive emails packed with the latest information and resources to live your best life and connect with others.

 
I Want to Contribute
I Need Help
  • Donate

    Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life.

  • Volunteer

    Join us and become a Champion of Yes. There are many volunteer opportunities available.

  • Live Yes! INSIGHTS

    Take part to be among those changing lives today and changing the future of arthritis.

  • Partner

    Proud Partners of the Arthritis Foundation make an annual commitment to directly support the Foundation’s mission.

Donate


Make a Donation

Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

Become a Member

Become an Arthritis Foundation member today for just $20. You'll receive a year's worth of Arthritis Today magazine, access to helpful tools, resources, and more.

Make a Honor or Memorial Gift

Honor a loved one with a meaningful donation to the Arthritis Foundation. We'll send a handwritten card to the honoree or their family notifying them of your thoughtful gift.

Volunteer


Volunteer Opportunities

The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.


More About Volunteering

Live Yes! INSIGHTS


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 


How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Get Started

 

Partner


Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

Visionary

Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

Pioneer

Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

Pacesetter

Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

Signature

Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

Supporting

Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.

More About Partnerships