Knee Replacement in Children: Indications, Risks & Outcomes

Overview

Total knee arthroplasty (TKA) in children and adolescents is exceedingly rare, reserved for end-stage joint destruction when all conservative measures have failed.

Indications

• Severe trauma (e.g., comminuted fractures with growth plate damage).
• Juvenile idiopathic arthritis (JIA) with irreversible joint destruction.
• Congenital or developmental disorders (e.g., Larsen syndrome, osteogenesis imperfecta).
• Tumor resection requiring joint reconstruction.
• Failed previous surgeries (osteotomy, arthrodesis).

Special Considerations

• Growth Plates: Implants may cross physis, affecting limb length; modular/expandable prostheses sometimes used.
• Bone Quality: Osteoporotic bone in JIA or steroid-treated patients complicates fixation.
• Activity Level: High demands accelerate wear; revision surgery likely in future.
• Multidisciplinary Decision: Pediatric orthopedist, rheumatologist, physiatrist, parents/patient.

Outcomes

• Significant pain relief and functional improvement reported in most series.
• 10-year implant survival ~80–90% (lower than adults due to higher activity, growth).
• Complications: infection, aseptic loosening, periprosthetic fracture, stiffness, leg-length discrepancy.

Alternatives Explored First

• Physical therapy, bracing, NSAIDs/biologics (for JIA).
• Arthroscopic debridement, synovectomy.
• Osteotomy (realignment).
• Arthrodesis (fusion) – sacrifices motion for stability.

Families should seek care at a pediatric orthopedic center with experience in complex joint reconstruction.