The Journal of Bone and Joint Surgery, Vol 70, Issue 6 821-833, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Involvement of the hip in juvenile rheumatoid arthritis. A longitudinal study
CM Harris and J Baum
University of Rochester School of Medicine and Dentistry, New York 14642.
Thirty-five children who had rheumatoid arthritis were followed for three
to twenty-two years. Four categories of involvement of the hip were seen.
In the first group, thirteen patients had mild disability and slight
radiographic changes. In six of those patients the disease was in remission
at the time of writing, and the patients were asymptomatic. In the second
group, two patients had episodic disability that correlated with the
activity of the disease. In the third group, fourteen patients had
progressive disability and radiographic changes. Fifty-five of the
fifty-nine procedures that were performed on the hip and knee in this
series were done on those fourteen patients. In the fourth group, six
patients had dramatic clinical and radiographic findings but, at the time
of the latest follow-up, had little functional disability. In all six of
these patients, the disease was in remission. In the children in this
study, protrusio acetabuli was more cephalad than has been found in adults
who have rheumatoid arthritis. All of the children had psychosocial
problems, but they responded well to counseling. These problems influenced
the timing of the surgical treatment.