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Evaluating Total Joint Replacements in Adolescents


Dr. Nathan Donaldson with a patient who had a total joint replacement.

What is postoperative life like for a kid who undergoes a total joint replacement?

Outside of solid tumors, a total joint replacement is a rare surgery for adolescents. There isn't a lot of information on surgical outcomes for this age group, so researchers at Children's Hospital Colorado are starting to collect it.

When you think of people who need a total joint replacement, adolescents rarely come to mind. As a pain control surgery, it's ideal for a person who is later in life — someone who likely won't have to worry about replacing the replacement. That's not the case for a kid, says orthopedic surgeon Nathan Donaldson, DO, because it won't last their whole life. And each time the device is replaced, there's a catch.

"The patient loses function," Dr. Donaldson says. "Less bone and muscle, more scar tissue. It makes it harder on the surgeon and the patient."

Other methods to control the pain are preferable, and when those methods fail, orthopedic surgery can offer relief. But because a total joint replacement it isn't a common orthopedic surgery procedure for kids, there isn't much data to show what postoperative life is like after one, let alone several over a lifetime. What is their pain level? Are they physically doing well? What about mentally?

Dr. Donaldson and affiliate researcher Nathan Rogers, MPH, are surveying a cohort of about 140 kids who've already undergone a total joint replacement at Children's Colorado in the last 16 years to start collecting those answers.

Are kids happy with a total joint replacement?

Most studies on pediatric joint replacement look at physician-reported scores, which does include assessment of pain, but they overlook other important markers like mental health.

"The novelty of our study is that we're asking, 'Are you, as a person, happy with what we've done to your joints?'," says Dr. Donaldson, "and that's really the most important thing we want to know."

They receive answers from patients through a survey given over the phone or privately in clinic. This method of patient-recorded outcomes is increasing in practice, Rogers says, because in addition to what a physician is assessing, it's important to understand what a patient thinks. Feedback differs depending on group, but overall, Rogers is seeing that both physical and mental scores for Children's Colorado patients fall within the national average.

What's next in total joint replacement research for kids

Rogers and Dr. Donaldson hope to continue enrolling patients as long as they're practicing.

"The biggest thing for us is continuing to get a comparison of quality of life and functional ability before and after their surgery," says Rogers. "It's the idea of saying, 'You start here and then you go up.' That's the goal of the research."

Postoperatively, they plan to follow up with a patient at two weeks, six weeks, three months, six months, one year and two years. They'll have the patient complete the outcomes survey each time, and they'll compare that with the physician assessment.

What's harder to gather is information on how often kids need replacements. That takes years to build. Ideally, they'd like to follow patients for at least 25 years. Over a lifetime is even better.

This type of long-term assessment on joint replacement in children could also help them track health-related quality of life. For example, there isn't yet a definitive link between joint replacement and heart health, but Dr. Donaldson says one could assume that kids are more active after a total joint replacement — meaning they might maintain a healthier heart throughout their life.

Kids go off to college, move away or transition to adult medical care. Historically, that's why this information has been so hard to record. But what Rogers and Dr. Donaldson see so far is, at least for a kid hitting 5 or 10 years out, that survival of the joint is good, and function is good.

"The kids — some who are now adults — are all pretty happy with it," says Rogers.