An ARHP session on Tuesday will feature speakers from physical therapy and orthopedic surgery specialties offering an overview of orthopedic management and subsequent rehabilitation of pediatric rheumatic conditions and sequelae, such as the need for total hip replacement in destructive juvenile idiopathic arthritis (JIA) and avascular necrosis (AVN) in the setting of chronic corticosteroids, including leg length discrepancy approaches.
During Orthopedic Management in Pediatric Rheumatology: When to Intervene Surgically?, Mark P. Figgie, MD, will discuss the orthopedic approach to hip and knee replacements in pediatric rheumatic patients. The session takes place from 2:30 – 4:00 pm in Room 10.
“When evaluating juvenile inflammatory arthritis (JIA) patients, for example, we generally try to avoid joint replacement because the anatomy is more challenging,” Dr. Figgie said. “But there are some patients where your hand is forced, and it’s better to operate on them before they have significant bone loss than it is to wait until they’ve destroyed their pelvis or they’ve ankylosed their knee. Generally, you really don’t want to wait any longer for JIA patients than you would for an adult patient.”
The effectiveness of newer medications, he said, has not only helped to improve outcomes but has reduced the need for joint replacement surgery in JIA patients.
“I used to commonly see patients who would come in with every joint involved and would need bilateral hips and bilateral knees just to get them up and walking,” Dr. Figgie said. “I don’t see as much of that anymore because the medications have helped, but they have not eliminated the problem, so we can’t get complacent about it.”
Dr. Figgie, Chief of the Surgical Arthritis Service at the Hospital for Special Surgery in New York, said it’s important that rheumatologists and orthopedic surgeons work together to manage pediatric patients and determine when surgical intervention is necessary.
“It’s never too early to get an orthopedic consult when these patients start getting joint problems,” he said. “Some people look at sending patients to the orthopedist as a failure of treatment, but it’s better to bring the orthopedist in before they’ve got a lot of joint involvement or joint destruction. That doesn’t mean I’m going to operate on them as soon as I see them, but the sooner I get to know them and follow them along with the rheumatologist, the better it is for the patient.”
Also during the session, Sue Maillard, MSC, SRP, MCSP, PT, a Physiotherapist at Great Ormond Street Hospital in London, will talk about the evaluation of children with arthropathy from a physical therapy/functional standpoint and how physical therapists work with orthopedic specialists and rheumatologists to manage these patients.
John Herzenberg, MD, will provide an update on the treatment of leg-length discrepancy in children with rheumatologic conditions. Dr. Herzenberg is Clinical Professor at the University of Maryland School of Medicine, Head of Pediatric Orthopedic Surgery at Sinai Hospital, and Director of the International Center for Limb Lengthening in Baltimore.