Total joint replacement in childhood arthritis.

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.