Synovectomy of the Hip in Patients with Juvenile Rheumatoid Arthritis

Carl, Hans-Dieter; Schraml, Annemarie; Swoboda, Bernd; Hohenberger, Gerd
September 2007
Journal of Bone & Joint Surgery, American Volume;Sep2007, Vol. 89-A Issue 9, p1986
Academic Journal
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 Ill 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'Aubignohip score. Results: Sixty-five (97%) of the sixty-seven hips were available for follow-up. The mean total Merle d'Aubigne 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.


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