Too Young For Joint Replacement?
Are the results worth the risk?

Researchers from the Mayo Clinic in Rochester, Minnesota,
reported in the Journal of Bone and Joint Surgery
(2003;85A:1090-1094) excellent results from knee replacement
surgery in children and teens with juvenile rheumatoid
arthritis in terms of pain relief and improved function.

Thirteen young patients were followed for an average of 11
years post-op.  Prior to surgery, two of the 13 said they
could not walk.  The others walked indoors only or for short
distance outdoors.  At the end of the follow-up period, six
patients reported they could walk more than six blocks.  One
patient remained wheelchair-bound.  Researchers added that4
4 of the young patients had to undergo additional surgery
though and many experienced complications of surgery.

Regarded as a "last resort" treatment, joint replacement
surgery can render tremendous pain relief for patients
suffering with severe arthritis. The hierarchy of treatment
plans for arthritis suggests that simple and conservative
steps be tried and exhausted. A variety of medications,
physical therapy, and a combination of exercise and rest
are commonly prescribed for the arthritis patient before
surgery is ever considered. Even by the time surgery is
presented as an option, a physician will likely choose
simpler procedures such as synovectomy before joint
replacement.

The intent is to get the best result with the most
conservative approach possible. Though joint replacements
are viewed as a highly successful surgical option, they are
also viewed as mechanical parts with limited lifespan. When
joint replacement surgery is indicated, the goal is to
achieve pain relief, regain function, correct deformity,
and prevent further damage. Pain relief is the primary
objective since function is not usually completely restored.

The limited lifespan of the prostheses suggest that revision
surgeries will be necessary in the future to correct for
their failure. Each subsequent surgery is more complicated
than the preceding procedure. The realization that younger
patients will require more revisions leads some doctors to
dissuade their patients. In the case of younger arthritis
patients, the benefits and risks of surgery must be
carefully deliberated.

The Duke University Medical Center Book Of Arthritis proposes
that the following questions be considered by any person
deciding on surgery:

   Is your pain unacceptable? Constant pain that does not
   respond to other treatment, keeps you awake at night,
   and interferes with work or activities is severe enough
   to require surgery.

   Do you require narcotic pain relievers? If you require
   daily medication at full allowable dosage to control
   pain, surgery may be indicated.

   Have you tried all other options to achieve pain relief?
   If the use of non-steroidal antiinflammatory drugs,
   physical therapy, rest, exercise, joint protection,
   remittive agents, and steroid injections has yielded
   unsatisfactory results, surgery may be a valid choice.

   Are your goals realistic? The rehabilitation process and
   the expected outcome of the surgery must be viewed
   realistically. Joint replacement surgery is not a cure,
   but it should offer restored comfort and function.

   Are you in good physical condition? Risk of complications
   will be low if your overall physical condition is good.

   Are you prepared to conscientiously follow a
   rehabilitative regimen? You must be psychologically
   prepared for months of exercises and physical therapy to
   restore joint function following joint replacement surgery.

Some patients end up in wheelchairs as they wait to grow old
enough to be considered a candidate for joint replacement
surgery. Surgery is delayed based on anticipated
complications. Yet the opposite perspective of some doctors
is that the severity of the disease and loss of function
warrant the surgery regardless of age. It becomes a quality
of life issue with the benefit of enhanced quality of life
weighed against potential risk.  Advancements in the design
of joint prostheses are leading to better results too.