The Journal of Bone and Joint Surgery (American). 2007;89:1986-1992.
doi:10.2106/JBJS.F.00657
© 2007 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 CME 3: July, August, September 2007 (publication date October 5, 2007; expi...
Pediatrics Test 14: Fall 2007 (publication date November 15, 2007; expirati...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Carl, H.-D.
Right arrow Articles by Hohenberger, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Carl, H.-D., Dr. med
Right arrow Articles by Hohenberger, G., Dr. med
Related Collections
Right arrow Pediatrics
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Synovectomy of the Hip in Patients with Juvenile Rheumatoid Arthritis

Hans-Dieter Carl, Dr. med1, Annemarie Schraml, Dr. med2, Bernd Swoboda, Prof. Dr. med1 and Gerd Hohenberger, Dr. med2

1 Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Rathsberger Strasse 57, D-91054 Erlangen, Germany. E-mail address for H.-D. Carl: Hans-Dieter.Carl{at}ortho-rheuma.med.uni-erlangen.de
2 Department of Orthopedic and Trauma Surgery, Wichernhaus, Rummelsberg 71, 90592 Schwarzenbruck, Germany

Investigation performed at the Department of Orthopedic and Trauma Surgery, Wichernhaus, Rummelsberg, Schwarzenbruck, Germany

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?