Staged Bilateral Total Hip and Knee Arthroplasties with Subsequent Hip Revisions in Juvenile Rheumatoid Arthritis: A Rare Case Report

Abstract

Abstract

Background:
Juvenile idiopathic arthritis (JIA), previously termed juvenile rheumatoid arthritis (JRA), is a chronic inflammatory condition that can result in severe joint destruction if inadequately treated. While pharmacologic advancements have significantly reduced the need for surgery, a subset of patients with refractory disease may progress to end-stage arthritis requiring total joint arthroplasty (TJA). Surgical management in this population presents unique challenges due to young age, anatomical deformities, and long-term disease burden.

Case Presentation:
We report the rare case of a young adult with longstanding JIA who underwent staged bilateral total hip arthroplasties (THA), followed by bilateral total knee arthroplasties (TKA), and subsequently required bilateral hip revision surgeries. The patient had a history of severe joint deformity, limited mobility, and prolonged corticosteroid use. A unique surgical strategy was employed for this patient: a staged, simultaneous primary total knee arthroplasty combined with contralateral revision hip arthroplasty. Autologous bone obtained during the knee procedure was used to reconstruct the acetabular defect encountered during the hip revision. Through multidisciplinary planning and staged interventions, the patient achieved significant functional improvement and pain relief.