Hip Replacement

If the term hip replacement conjures up the image of an elderly gray-haired lady, you aren’t alone. But did you know that young adults, teenagers, and even young children can sometimes require joint replacements too?

In fact, hip replacements are fairly common among juvenile arthritis patients.

A recent study concluded that these young people face the same concerns about artificial hip longevity as their older counterparts — and often for a longer period of time.

hip

It has been determined that hip replacements are effective for 10 to 20 years in patients with juvenile rheumatoid arthritis (JRA), also called juvenile idiopathic arthritis (JIA), the autoimmune form of arthritis that can strike at any age.

An artificial joint that can last a decade or two is a good fit for someone who is in their 60s or 70s — but is it a good call for a patient who is in their teen years and may need an additional two or three replacements in their lifetime?

Read More: Oh, Baby! Could Your Child’s Genes Predict Your Risk for Rheumatoid Arthritis? »

Rheumatologists Weigh in on Hip Replacement for Juveniles

Experts agree that total hip replacements are a good option to relieve pain in juvenile arthritis patients, and cite the 10- to 20-year span as a positive thing for these children and young adults who have severe pain and loss of function in their hip joints.

A study from Hospital for Special Surgery (HSS) in New York City found that total hip replacements lasted at least 10 years in 85 percent of juvenile arthritis patients, and that they lasted 20 years in 50 percent of patients.

Sometimes these hip implants wear out or are no longer viable. At that point the patient needs to have a new replacement put in or a revision surgery done. This is the same for juvenile and adult RA patients alike.

Joint replacement can free patients from a life of unrelenting pain. It can enable those in a wheelchair to walk again. Patients can go back to school or work and get their lives back.
Dr. Mark P. Figgie, Hospital for Special Surgery

“The surgery in this patient population, although performed by only a small number of specialized orthopedic surgeons, is life-changing for JIA patients,” said Dr. Mark P. Figgie, senior author of the study and chief of the Surgical Arthritis Service at HSS, in a statement to the press. “Joint replacement can free patients from a life of unrelenting pain. It can enable those in a wheelchair to walk again. Patients can go back to school or work and get their lives back.” 

Dr. Hema Srinivasalu, FACR, a pediatric rheumatologist from the Children’s National Health System, agrees there are benefits to hip replacements in young patients, but she also cautions there are some concerns that need to be considered when prescribing such a major procedure as a treatment option. 

“Due to recent advancements in the treatment of juvenile arthritis, we rarely encounter cases where we need to send patients for joint replacement,” she said.

If they do decide that a patient needs a hip replacement, they will wait until skeletal maturity is reached, which is typically around 16 to 18 years of age. 

“The lifespan of a total hip arthroplasty (THA) is assessed as survival rates with the end-result being revision surgery. In general, it is stated that survival rates for THA is lower in adolescents/young adults when compared to adults given the underlying disease, and increased wear and tear. However, outcomes have improved over the years,” she said. 

But how does one qualify for joint replacement such as this? 

“There are no rigid criteria as such for joint replacement. In clinical practice, consideration for joint replacement is given if the patient’s arthritis is severe and failed all treatment options currently available or arthritis has resulted in significant disability and pain due to early degenerative changes. Other considerations include status of other lower extremity joints, disease activity, and patient’s motivation to undergo rigorous rehabilitation before and after the surgery,” said Srinivasalu. 

Read More: New Biologic Drug Boosts Outlook for Kids with Juvenile Arthritis »

Patient Perspective on Juvenile Hip Replacements

Meg Stedman of Fort Worth, Texas, is a JRA patient who had a hip replacement at age 18. She is now 26 years old.

“My hip replacement has been very successful. I haven’t had any issues at all and feel 100 percent normal,” she said.

In a survey conducted on the Facebook page of Rheum to Grow: For Teens and Young Adults with Arthritis and Related Disease, patients with JRA received hip replacements anywhere from 9 to 29 years old, all with varying rates of success.

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