Surgery

Surgical treatment may be used in a very small number of children with juvenile rheumatoid arthritis (JRA) who have severe joint deformity, loss of movement, or pain. Surgery is a possible treatment option if your child has not improved with medicine and physical therapy and is unable to walk or perform manual tasks.

Surgery Choices

When surgery to correct joint deformity is needed, the more commonly used procedures include:

• Soft tissue releases of contractures, which involve cutting the muscles attached to an abnormally bent joint. As the muscles and other shortened tissues are released, the affected joint can return to a more normal position.
• Total joint replacement, which may be considered as a last resort for joints that have been so badly damaged by JRA that walking is very difficult or impossible. Important considerations for you to think about include your child's age, the number of joints involved in the disease, and the impact on your child's mobility.

Other surgical procedures that have been used in children with JRA but are recommended only in selected cases include:

• Osteotomy, which involves removing a wedge of bone to allow more normal alignment of the joint. An osteotomy may be recommended for children who have severe joint contractures.
• Epiphysiodesis, in which the portion in a long leg bone where growth occurs is removed in order to stop growth.
• Synovectomy or tenosynovectomy, rarely used for JRA. Synovectomy involves the surgical removal of the joint lining (synovium) and/or the covering of the tendon (tenosynovectomy) to reduce joint inflammation.
• Arthrodesis, rarely used in children, which involves the fusion of two bones in a diseased joint so that the joint can no longer move.

What To Think About

The main things to think about for surgery during childhood are the child's age and whether his or her bones are still growing. When considering total joint replacement, it is also important to consider the possibility of needing another joint replacement in 10 to 20 years. The timing often requires a balance between the child's age, the expected life of the replaced joint, and the possible loss of bone and muscle strength if surgery is delayed too long.