Synovectomy of the hip in patients with juvenile rheumatoid arthritis.
BACKGROUND
There is a lack of data on the functional effect of open hip synovectomy in a large number of patients with juvenile rheumatoid arthritis evaluated with a validated assessment tool.


METHODS
Between 1985 and 1997, sixty-seven open hip-joint synovectomies were carried out in fifty-six patients with juvenile rheumatoid arthritis. Fifty-five hips (82%) had radiographic changes that were stage III or higher according to the system of Larsen et al. Hip function was evaluated preoperatively and after a mean of fifty months with the Merle d'Aubigné hip score.


RESULTS
Sixty-five (97%) of the sixty-seven hips were available for follow-up. The mean total Merle d'Aubigné hip score (and standard error of the mean) was significantly improved from 9.5 +/- 2.5 points at baseline to 16.3 +/- 1.0 points at the time of follow-up (p < 0.001). The individual scores for pain, mobility, and walking ability were significantly increased as well (all p < 0.001). Eighty-five percent of the hips were observed to have a very great or great improvement in function. A concomitant soft-tissue release was performed in seven hips, and nine hips required surgical dislocation. Surgical complications included two superficial wound hematomas that did not require intervention; osteonecrosis of the femoral head was not observed. Five hips required total hip arthroplasty during the follow-up period. Thus, the survival rate for the hips was 94% at a mean of four years following the synovectomy.


CONCLUSIONS
Open hip synovectomy in patients with juvenile rheumatoid arthritis is a safe procedure that can improve hip-joint function for up to five years.
Carl
Hans-Dieter
HD
Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Rathsberger Strasse 57, D-91054 Erlangen, Germany. Hans-Dieter.Carl@ortho-rheuma.med.uni-erlangen.de
Schraml
Annemarie
A
Swoboda
Bernd
B
Hohenberger
Gerd
G
D000293:Adolescent; D000328:Adult; D001171:Arthritis, Juvenile / Q000145:classification / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip; D002648:Child; D003475:Curettage; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D015996:Survival Rate; D000074402:Synovectomy; D016138:Walking / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology