Biliography on hip problems in JCA
Bibliographie sur les problèmes de hanche dans l'ACJ
05 Oct 98

1. Haber, D. and Goodman, S. B. Total hip arthroplasty in juvenile chronic arthritis: a consecutive series. J Arthroplasty 13(3), 259-265. 1998.
   Division of Orthopaedic Surgery, Stanford University School of Medicine, California, USA.
   Notes: Twenty-nine total hip arthroplasties in 16 patients with juvenile chronic arthritis were performed by one surgeon and followed prospectively. The 9 female and 7 male patients averaged 21 years of age (range, 14-35). Height and weight averaged 160 cm (63 inches) and 53 kg (118 lb.), respectively. Preoperative planning used small or miniature components to accommodate the small anatomic proportions of the hip. The femoral component was cementless in the majority (20/29), but required cementing in 10 of 29 hips because of poor bone stock. The acetabula were reconstructed with a porous-coated cup with or without screws (27/29) or with a cemented cup (2/29). Follow-up periods averaged 53 months (range, 24-100 months). The average Harris hip score improved from 37 to 78 after surgery (P = .0001). Pain relief was excellent; 15 of 16 patients (27/29 hips) expressed a significant improvement in daily function and lifestyle, despite systemic involvement of their arthritis. The range of motion of the hip improved significantly in all planes (P = .001). Two of the 4 uncemented Muller CDH components (Protek, Bern, Switzerland) with a large offset have migrated into varus; both are pain-free. One cemented femoral component has been revised because of aseptic loosening. The use of a small or miniature, cemented or cementless femoral component and a porous-coated cup appears to provide an excellent method of hip reconstruction for patients with juvenile chronic arthritis and small anatomic proportions; however, a femoral component with too great an offset should be avoided, because this may result in varus migration of the stem
   Type: JOURNAL ARTICLE
2. Chmell, M. J., Scott, R. D., Thomas, W. H., and Sledge, C. B. Total hip arthroplasty with cement for juvenile rheumatoid arthritis. results at a minimum of ten years in patients less than thirty years old. Journal of Bone and Joint Surgery - Series A 79, 44-52. 1997.
   USA
   Notes: We retrospectively reviewed the clinical and radiographic results of total hip arthroplasty with cement in patients with juvenile rheumatoid arthritis who were less than thirty years old at the time of the index procedure. Thirty-nine patients (sixty- six hips) were managed with this procedure at our institution between 1971 and 1983. Six patients (eleven hips) died before a minimum of ten years of follow-up; the remaining thirty- three patients (fifty-five hips) were followed for at least eleven years. Twenty-eight patients (forty-six hips) had at least one original component in situ after an average duration of clinical follow-up of 15.1 years, and twenty-three of these patients (thirty-eight hips) were followed radiographically for an average of 14.7 years. At the time of the latest follow-up examination, all twenty-eight patients were able to walk outside the home; twenty of these patients (thirty-five hips; 76 per cent) had no pain with activity, and eight patients (eleven hips; 24 per cent) had mild- to-moderate pain with activity. Over-all, twelve (18 per cent) of the sixty- six femoral components and twenty-three (35 per cent) of the sixty-six acetabular components were revised after an average of 12.8 and 11.8 years, respectively. The fifteen-year survival rate for the femoral components was 85 per cent with revision or radiographic loosening as the end point. The fifteen-year survival rate for the acetabular components was 70 per cent with revision as the end point and 61 per cent with revision or radiographic loosening as the end point. The benefits of total hip arthroplasty were maintained over the long term in most of our patients who had juvenile rheumatoid arthritis. However, the durability of the components in these young patients remains a concern
3. Fantini, F., Corradi, A., Gerloni, V., Failoni, S., Gattinara, M., Aprile, L., Ferraris, W., and Arnoldi, C. The natural history of hip involvement in juvenile rheumatoid arthritis: a radiological and magnetic resonance imaging follow-up study. Rev Rhum Engl Ed 64(10 Suppl), 173-178. 15-10-1997.
   Chair of Rheumatology, University of Milan, Center for Rheumatic Children, Gaetano Pini Institute, Italy.
   Notes: Type: JOURNAL ARTICLE
   Type: REVIEW
   Type: REVIEW, TUTORIAL
4. Fedrizzi, M. S., Ronchezel, M. V., Hilario, M. O., Lederman, H. M., Sawaya, S., Goldenberg, J., and Sole, D. Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid arthritis. J Rheumatol 24(9), 1820-1825. 1997.
   
   Notes: 97438321 Address: Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Brazil OBJECTIVE: To determine the value of ultrasonography in detection of early alterations and subsequent evolution of hip joint disease in patients with juvenile rheumatoid arthritis (JRA). METHODS: Hip joints of 53 patients were evaluated clinically, by conventional radiography and ultrasound. Ten children free of signs/symptoms related to rheumatic diseases were chosen as a control group. Nine patients were followed up 28 months after baseline examinations. The clinical, radiological, and ultrasound evaluations were repeated. RESULTS: Conventional radiography showed alterations in 10 patients (18.9%) who had shown clinical manifestations of advanced disease of the hip joint while ultrasound detected abnormalities in asymptomatic patients who had had normal radiographs. Ultrasound revealed the occurrence of 47.2% involvement in the hips of patients with JRA. Thus, ultrasound was apparently more sensitive than conventional radiographs in diagnosing changes in the hip joints of patients with JRA. Further, such involvement was found with greater frequency in the systemic and polyarticular types of JRA, in children less than 5 years of age, in those with longer duration of disease, and in those who belonged to a poorer functional class. In 3 of 9 patients who initially had normal radiographs and altered ultrasound, we found severe hip alterations upon reevaluation by radiography, after a period ranging from 21 to 39 months. CONCLUSION: Ultrasonography is a method of diagnosis that must be considered in hip joint evaluation of patients with JRA Type: JOURNAL ARTICLE ISSN: 0315-162X Language: Eng
5. Hafner, R. Influence of inflammation and muscular imbalance on growth and form of the hip in juvenile chronic arthritis. Rev Rhum Engl Ed 64(10 Suppl), 169-172. 15-10-1997.
   Hospital for Pediatric Rheumatology, Garmisch-Partenkirchen, Germany.
   Notes: Type: JOURNAL ARTICLE
   Type: REVIEW
   Type: REVIEW, TUTORIAL
6. Lehtimaki, M. Y., Lehto, M. U., Kautiainen, H., Savolainen, H. A., and Hamalainen, M. M. Survivorship of the Charnley total hip arthroplasty in juvenile chronic arthritis. A follow-up of 186 cases for 22 years. J Bone Joint Surg Br 79(5), 792-795. 1997.
   Tampere University Hospital, Finland.
   Notes: Between 1971 and 1991 we performed Charnley low-friction arthroplasty (LFA) on 116 patients (186 hips) with juvenile chronic arthritis (JCA). We have now carried out a survival study, taking endpoints as revision, death or the end of the year 1993. Overall survival was 91.9% at ten years and 83.0% at 15 years. That of the femoral component was 95.6% at ten years and 91.9% at 15 years and of the acetabulum 95.0% and 87.8%, respectively. Only the use of steroids significantly impaired the survival. We therefore recommend the use of Charnley LFA for young patients with JCA requiring total hip replacement
   Type: JOURNAL ARTICLE
7. Spamer, M. Conservative treatment of the hip in juvenile chronic arthritis. Rev Rhum Engl Ed 64(10 Suppl), 179-182. 15-10-1997.
   Hospital for Pediatric Rheumatology, Garmisch-Partenkirchen, Germany.
   Notes: Type: JOURNAL ARTICLE
   Type: REVIEW
   Type: REVIEW, TUTORIAL
8. Journeau, P., Mabesoone, F., Touzet, P., Prieur, A. M., and Rigault, P. Total hip arthroplasty for chonic juvenile arthritis: a 34 case review <original> arthroplastie totale de hanche dans l'arthrite chronique juvenile. revue d'une serie de 34 protheses. Revue de Chirurgie Orthopedique et Reparatrice de l'Appareil Moteur 82(6), 508-521. 1996.
   Service d'Orthopédie-Traumatologie Infantile, Hôpital des Enfants Malades, Paris.
   Notes: De 1984 a 1992, 20 patients atteints d'arthrite chronique juvenile suivisa l'Hopital Necker-Enfants Malades ont beneficie d'une arthroplastietotale de hanche. Cela represente une serie de 34 protheses, qui sonten majorite des protheses de type Zweymuller non cimentees. Au reculmoyen de 5 ans, le resultat fonctionnel a ete tres satisfaisant puisquedans plus de 85 p. 100 des cas, la reprise d'une activite courante aete obtenue. Par ailleurs, le gain sur la douleur a ete egalement tresimportant puisque l'indolence a ete obtenue dans plus de 80 p. 100 descas. Outre les bons resultats cliniques au recul moyen dont nousdisposons, l'interet de l'etude reside dans le fait que 2 periodes sonta distinguer dans la technique operatoire avec l'emploi de materielcimente dans une premiere periode puis l'emploi d'un implant femoralnon cimente et d'un cotyle visse. La comparaison de ces 2 techniques apermis de retenir que l'emploi de protheses non cimentees parait unesolution satisfaisante dans cette pathologie tres particuliere, enpreservant le capital osseux avec des resultats a moyen termefavorables. Par ailleurs, le tres faible taux de complications relevedans la serie, malgre le terrain, incite a retenir l'arthroplastietotale de hanche dans l'arsenal therapeutique de l'arthrite chroniquejuvenile
   
   Purpose of the study. The purpose of this study was to analyse the results of total hip arthroplasty for chronic juvenile arthritis in order to evaluate risks, problems and benefits of this procedure. Material and methods. Between 1984 and 1992, 34 total hip prostheses were implanted for chronic juvenile arthritis in 20 patients. Most prostheses were Zweymuller cementless prostheses. Mean follow up was 5 years. Results Results. were good. In 85 per cent of cases, patients had a normal activity recovery. Pain relief was very good since in 80 per cent cases patients had a total indolence. Discussion. Beyond these good clinical results at this mean follow-up, the main interest of this study is to characterize two different periods in the surgical technique. The first period when cemented prosthesis was employed and the second one when cementless femoral implants with screwed acetabular component were used. Cementless prostheses appear to be a satisfying solution in this disease, preserving bones and showing very good radiological and functional results. Conclusion. Furthermore, the very low complication rate despite general discomfort may prompt us to use total hip arthroplasty for the treatment of chronic juvenile arthritis
9. Schmalzried, T. P., Szuszczewicz, E. S., Akizuki, K. H., Petersen, T. D., and Amstutz, H. C. Factors correlating with long term survival of mckee-farrar total hip prostheses. Clinical Orthopaedics and Related Research -, S48-S59. 1996.
   USA
   Notes: Clinical and radiographic evaluations of 15 McKee-Farrar hip replacements in 13 patients with followup of 21 to 26 years were performed. The average Harris hip score was 86 with no patients having a poor result. These patients outscored the age matched controls in all categories of the SF-36 health survey. All patients were community ambulators with qualitative activity levels exceeding the average for their age. Quantitative activity assessment with a pedometer in 3 patients indicated a current average of approximately 900,000 cycles per year. This represents more than 21 million cycles when extrapolated during the life of the implants. None of the femoral components were radiographically loose. One acetabular component may be loose. Osteolysis developed in 3 apparently well fixed femurs and in 1 acetabulum. There were several features of these cases that may have contributed to the long survival: (1) relatively small stature of the patients who averaged 160.5 cm (5 feet 5 inches) in height and 66.9 kg (147 lbs) in weight; (2) favorable biomechanics of the reconstruction with the hip center of rotation being medialized by an average of 6.4 mm and the femoral offset increased by an average of 4.9 mm; (3) decreased potential for neck socket impingement with an average lateral acetabular opening of 54degree and all components were anteverted; (4) radiolucent cement in 13 of 15 hips; and (5) no radiographically measurable wear. Previous analyses and comparisons of the clinical performance of the McKee-Farrar implant have focused on the metal on metal bearing. As has been recognized with the many variations of total hip replacement using metal on plastic bearings, there are a myriad of variables that contribute to clinical outcome. The results of this study suggest that patient selection and technical factors may contribute to the long term survival, and conversely to the failure, of McKee-Farrar implants
10. Schmalzried, T. P., Fowble, V. A., Ure, K. J., and Amstutz, H. C. Metal on metal surface replacement of the hip: technique, fixation, and early results. Clinical Orthopaedics and Related Research -, S106-S114. 1996.
    USA
    Notes: High volumetric wear of polyethylene plays a central role in periprosthetic bone resorption and the failure of metal on polyethylene total hip resurfacing prostheses. An assessment of technique, initial fixation, and the early results of 21 hips in 19 patients implanted with a metal on metal bearing total hip resurfacing prosthesis, 4 all cementless Wagner prostheses and 17 all cemented McMinn prostheses, is presented. Pain relief was equal to conventional total hip replacement with a better functional result with an average followup of 16 months (range, 10-25 months). The femoral component position and fixation is satisfactory in all 21 hips and there were no femoral neck notches or fractures. All 4 cementless Wagner acetabular components appear to be osseointegrated with stable interfaces. The cemented McMinn acetabular components, however, have shown progressive cement bone interface radiolucencies in 12 hips. This preliminary experience underscores the importance of obtaining secure initial fixation. There have been no problems directly attributable to the metal on metal bearing but the authors will continue to follow these hips and evaluate their performance. The metal on metal hip surface replacement procedure is in evolution. This ongoing experience will help guide total hip surface replacement component design and implantation techniques
11. Wedge, J. H. and Cummiskey, D. J. Primary arthroplasty of the hip in patients younger than 21 years of age. Instr.Course.Lect. 44, 275-280. 1995.
    Hospital for Sick Children, University of Toronto, Ontario, Canada.
12. Boehnke, M., Behrend, R., Dietz, G., and Kuster, R. M. Intraarticular hip treatment with triamcinolonehexacetonide in juvenile chronic arthritis. Acta Univ Carol [Med] (Praha) 40(1-4), 123-126. 1994.
    Department of Paediatric Rheumatology, Rheumaklinik Bad Bramstedt, Germany.
    Notes: To evaluate the effect and tolerance of intraarticular Triamcinolonehexacetonide (TCH) in the course of chronic coxitis in juvenile chronic arthritis (JCA) in an open uncontrolled study. Since 1990 we treated patients < 16 years of age suffering from chronic coxitis with 1 mg/TCH/KG body weight. The patients were checked again 4-8 weeks after the treatment. Clinical and ultrasound courses were recorded with the help of ultrasound and joint scores. The evaluation took place 6, 12, 24 and 36 months after the treatment. At that time we give a report on the 12 months follow-up of 37 hip joints and the 24 months follow-up of 20 hip joints. The immediate effect of TCH influencing mobility, pain sensitivity and joint effusions of the patients is impressing. The long term effect of TCH has to be evaluated by regular check ups for at least 2 years. An individual comparison with the not treated contralateral joint would be desired if ethically justifiable. Most patients suffering from polyarticular diseases with a long course of coxitis needed more than one injection of TCH (mean reinjection time 5.8 months). Any avascular necrosis of the femoral heads or other complications were not observed
    Type: JOURNAL ARTICLE
13. Hastings, D. E., Orsini, E., Myers, P., and Sullivan, J. An unusual pattern of growth disturbance of the hip in juvenile rheumatoid arthritis. J.Rheumatol. 21(4), 744-747. 1994.
    Wellesley Hospital, Division of Orthopaedic Surgery, University of Toronto, ON, Canada.
    Notes: OBJECTIVE. An unusual deformity in the hip in juvenile rheumatoid arthritis (JRA) consisting of a small femoral head in a capacious acetabulum has been described as an isolated finding, but no explanation as to the cause of the deformity has been proposed. We have also observed this deformity and the objective of this investigation was to determine the cause. METHODS. In 1987, a review of hip disease in JRA was carried out at the Wellesley Hospital. Nine hips in 5 patients were identified as having a mismatch in size between the femoral head and acetabulum. Six of these hips came to surgery during the growth phase. RESULTS. The 6 hips undergoing surgery between the ages of 16-19 showed an identical picture at the time of surgery. The pattern of pathology consisted of a femoral head devoid of articular cartilage and an acetabulum that showed an intact triradiate cartilage. Each of the 6 hips was treated with a resurfacing arthroplasty. CONCLUSION. The femoral head grows in circumference by endochondral ossification of the articular cartilage. If the rheumatoid process destroys that articular cartilage, growth of the femoral head ceases. The intact triradiate cartilage permits continuing acetabular growth and the deformity of a small femoral head in a large capacious acetabulum results
14. Hayem, F., Calede, C., Hayem, G., and Kahn, M. F. [Involvement of the hip in systemic-onset forms of juvenile chronic arthritis. Retrospective study of 28 cases] L'atteinte de la hanche au cours des formes a debut systemique d'arthrite chronique juvenile. Etude retrospective de 28 cas. Rev.Rhum.Ed.Fr. 61(9), 583-589. 1994.
    Clinique de Rhumatologie, Hopital Bichat-Claude Bernard, Paris (FRANCE)
    Notes: The objective of this work was to evaluate the course of hip disease in patients with systemic-onset juvenile chronic arthritis. 59 patients with systemic-onset juvenile chronic arthritis followed-up for a mean of 15 years (+/- 6 years) were studied retrospectively. 28 patients (47.5%) had involvement of the hip. Mean age at onset of symptoms of hip disease was 9.5 years (+/- 5 years). Hip arthritis was always preceded by other manifestations of the disease, including arthritis of other lower limb joints. Mean time interval between onset of the disease and onset of hip symptoms was 6.3 years (+/- 3 years). In 66% of cases, symptoms occurred simultaneously in both hips. Eight of nine patients with initially unilateral hip arthritis subsequently developed arthritis of the other hip; in four patients, less than one year elapsed between involvement of the two hips. Roentgenographic changes were variable and included acetabular protrusion (25%), complex cervico-cephalic and acetabular growth disorders (21%), subdislocation (18%), a short femoral neck with varus deformity (14%), and a long femoral neck with valgus deformity (14%). Avascular necrosis of the femoral head occurred in three patients. Roentgenographic evidence of repair was seen in one patient. Among the ten patients who required surgery, two had corrective osteotomy with adductor tenotomy and eight had total hip arthroplasty (of both hips in six patients) with good short- and medium-term outcomes. After arthroplasty, a single patient required reoperation in the short term, for persistent flexion contracture. Loosening of the acetabular arthroplasty required revision in two patients 5 and 10 years, respectively, after the initial procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
15. McCullough, C. J. Surgical management of the hip in juvenile chronic arthritis. Br.J.Rheumatol. 33(2), 178-183. 1994.
    
    Notes: The hip joint is the most important joint as far as surgical management of JCA is concerned. Approximately a third of children will develop hip involvement, leading to pain and deformity. A wide spectrum of hip joint abnormalities may occur, being the result of either under-development or over-development of the bones and erosive change secondary to the synovitis. For the acutely irritable hip with no fixed deformity an intra-articular injection of Triamcinolone Hexacetonide may be beneficial. For those hips with a fixed deformity, resulting in functional impairment in children prior to the closure of the proximal femoral capital epiphysis, a soft tissue release of selected muscles around the hip joint can correct deformity and improve function. For the painful destroyed hip joint, total joint replacement is indicated. Cemented hip replacements have been shown to have a high incidence of loosening in this patient group and consideration is being given to the use of customized uncemented femoral components 0 (Anti-Inflammatory Agents, Steroidal);5611-51-8 (triamcinolone hexacetonide);76-25-5 (Triamcinolone Acetonide)
16. Witt, J. D. and McCullough, C. J. Anterior soft-tissue release of the hip in juvenile chronic arthritis. J.Bone Joint Surg.Br. 76(2), 267-270. 1994.
    Department of Orthopaedic Surgery, Northwick Park Hospital, Middlesex, UK.
    Notes: We report the results of anterior soft-tissue release of the hip for fixed flexion deformity in 17 patients (31 hips) with juvenile chronic arthritis. The mean age at operation was 8 years 6 months. All the patients were reviewed at one and three years and 11 (21 hips) were available for review at five years. The results were good as regards early pain relief and improved mobility. At one year, the average fixed flexion deformity was reduced from 35 degrees to 9.5 degrees, and at three years it was 18 degrees. This degree of improvement was maintained in the hips followed for five years. At 5 to 12 years' follow-up (mean 6.7) seven patients (14 hips) have required no further surgery and have maintained an acceptable range of motion. We discuss the influence of surgery on radiographic changes and on femoral neck anteversion
17. Franzen, H., Mjoberg, B., and Rydholm, U. Metal backing improves the survival of surface replacement of the hip. Arch.Orthop.Trauma.Surg. 112(6), 257-259. 1993.
    Department of Orthopedics, Lund University Hospital, Sweden.
    Notes: Nineteen patients with juvenile chronic arthritis underwent 29 resurfacing hip arthroplasties. In 22 the original all-plastic Wagner acetabular component was used and in 7 the metal-backed Wagner-Tillmann component. After a mean of 11 (range 8-13) years 19 of the Wagner acetabular components had been revised and another 2 showed radiographic loosening. After a mean of 7 (range 5-9) years no metal-backed acetabular cup had been revised and only 1 was definitely loose
18. Hamalainen, M. Surgical treatment of the hip and knee joint in juvenile rheumatoid arthritis. Ryumachi. 33(6), 473-473. 1993.
    Rheumatism Foundation Hospital, Heinola, Finland.
19. Lloyd, J. and Aldrich, S. Second workshop on physiotherapy in JCA Garmisch-Partenkirchen. Br.J.Rheumatol. 32(5), 425-425. 1993.
    
    Notes: 93265234 Northwick Park Hospital, Harrow (ENGLAND) 0263-7103 ENGLISH 9308 AIM^INDEX MEDICUS
20. Maric, Z. and Haynes, R. J. Total hip arthroplasty in juvenile rheumatoid arthritis. Clin.Orthop. (290), 197-199. 1993.
    Children's Rehabilitative Services, Phoenix, Arizona 85013.
    Notes: A series of 17 primary total hip arthroplasties in patients with juvenile rheumatoid arthritis (JRA) were performed at a mean age of 18 years with an average follow-up period of 9.3 years. There were 13 cemented prostheses and four noncemented. All patients were satisfied with their hip surgery and reported either slight or no hip pain according to the Harris hip rating system. Ambulation improved postoperatively and all but one patient was at least a limited community ambulator (able to ambulate short distances outside the home with crutches, walker, or cane). Roentgenogram evaluation showed five cemented hips that were believed to be definitely loose with impending failure. All were functioning well. One acetabular component has been revised to date. No femoral components have been revised. The four noncemented hips with an average follow-up period of five years were functioning well
21. Swann, M. Total hip replacement for juvenile chronic arthritis. Clin.Exp.Rheumatol. 11 Suppl 9, S47-9. 1993.
    Consulting Rooms, Windsor, UK.
22. Williams, W. W. and McCullough, C. J. Results of cemented total hip replacement in juvenile chronic arthritis. A radiological review. J.Bone Joint Surg.Br. 75(6), 872-874. 1993.
    Northwick Park Hospital, Harrow, England.
    Notes: We assessed 57 total hip arthroplasties in 34 adolescents with juvenile chronic arthritis using standard radiological techniques at an average of 4.7 years (20 months to 9 years) after surgery. The incidence of overall loosening was 24.6% (14 hips), but hips with a follow-up of more than five years had a loosening rate of 43.5% (10 hips; p < 0.01)
23. Cage, D. J., Granberry, W. M., and Tullos, H. S. Long-term results of total arthroplasty in adolescents with debilitating polyarthropathy. Clin.Orthop. (283), 156-162. 1992.
    Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas 77030.
    Notes: The authors retrospectively reviewed 29 hip and 13 knee arthroplasties performed in 17 adolescents and young adults from 1973 through 1979. Most patients had severe multiple joint involvement; 16 had juvenile rheumatoid arthritis. Clinical and roentgenographic evaluations were performed before operation and at routine intervals for up to 11 years after operation. The average final follow-up evaluation was at ten years seven months. The modified Harris rating improved from 17 before operation to 68 at final evaluation. A dramatic improvement was noted in the ambulatory ability of 13 patients in whom increased joint motion and reduced deformity was observed at follow-up evaluation. At the 11-year roentgenographic review, 32% of hips had gross loosening, and an additional 39% had radiolucent lines greater than 2 mm in thickness in more than two radiographic zones. No lucency greater than 2 mm was noted in any of the knee replacements. Complications included one immediate collapse of the medial tibial plateau, four femoral fractures, one hip dislocation, and one case of arthrofibrosis. Despite untoward roentgenographic results and the high incidence of complications, total arthroplasty has dramatically improved the quality of life for these patients with multiple joint pathology. For this reason, the authors continue to recommend joint replacement in these individuals and the use of new prosthetic designs and surgical techniques
24. Heimkes, B. and Stotz, S. [Results of late synovectomy of the hip in juvenile chronic arthritis] Ergebnisse der Spatsynovektomie der Hufte bei der juvenilen chronischen Arthritis. Z.Rheumatol. 51(3), 132-135. 1992.
    Orthopadische Univ.-Poliklinik Innenstadt, LMU Munchen.
    Notes: The aim of this study was to examine the indication for total synovectomy of the hip in juvenile chronic arthritis. For this purpose, five children with six treated hips were followed up. At the time of synovectomy all patients were suffering from therapy resistance and progressive destructive coxitis, as a result of juvenile chronic arthritis. The procedure carried out must, consequently, be regarded as late synovectomy. At the time of the follow-up examination--at least 2 years after the operation--all patients had lasting relief from pain. The range of hip movement could not be improved, despite being accompanied by tenotomies and consistent rehabilitation in the postoperative years. The functional capacity in everyday life also failed to improve. During the post-operative radiographic follow-up the deterioration of the hips proceeded more rapidly than expected for this spontaneous course of treatment. The results lead to the conclusion that the relief of pain due to a late synovectomy of the hip is achieved at the expense of a rapidly progressive destruction of the joints. For this reason, the late synovectomy of the hip in juvenile chronic arthritis should be regarded as the last possibility where resistance to conservative therapy exists
25. Jacobsen, F. S., Crawford, A. H., and Broste, S. Hip involvement in juvenile rheumatoid arthritis. J.Pediatr.Orthop. 12(1), 45-53. 1992.
    Marshfield Clinic, Wisconsin 54449.
    Notes: We followed 386 children who met the criteria for juvenile rheumatoid arthritis (JRA) an average of 89 months. Hip involvement in JRA results in poor functional capacity. The prognosis for the pauciarticular group is good, but patients with onset at age greater than 6 years appear to do worse than those aged less than 6 years. In the polyarticular group, age of onset did not change the prognosis, whereas the systemic-onset group aged less than 6 years had a worse prognosis and more frequent radiographic changes than the older group
26. Moreno Alvarez, M. J., Espada, G., Maldonado-Cocco, J. A., and Gagliardi, S. A. Longterm followup of hip and knee soft tissue release in juvenile chronic arthritis. J.Rheumatol. 19(10), 1608-1610. 1992.
    
    Notes: 93100705 Rheumatology Section, Instituto Nacional de Rehabilitacion, Buenos Aires, Argentina (CANADA) 0315-162X ENGLISH 9303 INDEX MEDICUS Longterm results of soft tissue release for hip and knee flexion deformity in 27 patients with juvenile chronic arthritis (JCA) were evaluated. A total of 53 tenotomies were reviewed: 22 hips and 31 knees. Mean age at surgery was 12.1 years, with a mean underlying disease duration of 6.3 years and a postoperative followup of 5 years. Patients were evaluated at 3- 6 months, then at one, 3 and 5 years. Results showed a marked drop in flexion contracture and an improvement in joint range up to the first 3 years postsurgery, but beyond this period benefits achieved were gradually partially lost. Only 37% of patients were able to walk before surgery. At one year followup, 81% were able to do so. Soft tissue release thus seems a beneficial therapeutic alternative to preserve both alignment and function in hip and knee flexion deformity affecting patients with JCA
27. Hyman, B. S. and Gregg, J. R. Arthroplasty of the hip and knee in juvenile rheumatoid arthritis. Rheum.Dis.Clin.North Am. 17(4), 971-983. 1991.
    Robert Wood Johnson Medical School, New Brunswick, New Jersey.
    Notes: The primary reason for total hip and total knee replacement in patients with juvenile rheumatoid arthritis is marked functional impairment. Secondary reasons are severe disabling pain and deformity. By the time a patient is ready for arthroplasty, alternatives to surgery have already been considered; synovectomies, soft-tissue releases, and osteotomies have already been performed, or the destructive process is too advanced for any form of therapy to have a considerable effect
28. McGraw, R. W., Morton, K. S., and Duncan, C. P. Massive intrapelvic synovial cyst as a complication of total hip replacement arthroplasty: a case report. Can.J.Surg. 34(3), 267-269. 1991.
    Department of Orthopedics, University of British Columbia, Vancouver.
    Notes: The authors report a case of massive intrapelvic synovial cyst complicating total hip arthroplasty in a 35-year-old woman with rheumatoid arthritis. The clinical presentation raised the possibility of a coincidental soft-tissue malignant tumour. This was ruled out by ultrasonography, computed tomography, fine- needle aspiration with examination of cells and culture and, ultimately, by image intensification in the operating room during aspiration of the cyst and injection of the adjacent hip joint with Hypaque. The authors conclude that perforation of the acetabular floor at total hip arthroplasty was likely the precipitating event. After 1 year there was no indication for surgical excision of the cyst
29. Witt, J. D., Swann, M., and Ansell, B. M. Total hip replacement for juvenile chronic arthritis. J.Bone Joint Surg.Br. 73(5), 770-773. 1991.
    Wexham Park Hospital, Slough, England.
    Notes: We review the results of 96 primary total hip replacements in 54 patients with juvenile chronic arthritis at five years or longer after surgery. The mean age at operation was 16.7 years (range 11.25 to 26.6); the follow-up period averaged 11.5 years. The clinical results in terms of pain, range of movement, mobility and function are presented. A revision procedure was required in 24 hips (25%) in 18 patients at an average of 9.5 years after the primary operation. A further 17 hips had radiographic signs of loosening. The factors thought to contribute to this relatively high failure rate in patients with juvenile chronic arthritis are discussed
30. Aliakin, L. N. and Zhila, N. G. [Rehabilitation treatment of children with rheumatoid arthritis after operations on the hip joint] Vosstanovitel'noe lechenie detei s revmatoidnym artritom posle operatsii na tazobedrennom sustave. Ortop.Travmatol.Protez. (5), 28-32. 1990.
    
    Notes: The authors present their experience in the recovery treatment of 37 children suffering from rheumatoid arthritis after 40 treatment-and-prophylactic and reconstructive operations on the hip joint. The peculiarities++ of drug therapy and hormonal protection during the postoperative period are reflected. The terms of starting the performance of passive and active movements in the operated joint are given, as well as the terms of partial and complete loading of the extremity with regard to the state of the muscle function, the bone structure and the function of the operated and other affected joints. The sequence of using the methods of physiotherapy and therapeutic physical training is pointed out. The necessity of complex use of these means of treatment is stressed
31. Hall, R. Juvenile rheumatoid arthritis: a child crippled. N.C.Med.J. 51(12), 643-644. 1990.
    Wiggins and Company, Raleigh 27613.
32. Scott, R. D. Total hip and knee arthroplasty in juvenile rheumatoid arthritis. Clin.Orthop. (259), 83-91. 1990.
    Harvard Medical School, Boston, Massachusetts.
    Notes: Total hip or knee arthroplasty is indicated in patients with juvenile rheumatoid arthritis when there is marked functional impairment and/or severe disabling pain from advanced structural hip or knee joint involvement. Relief of pain and dramatic improvement in function can be achieved in most patients. When both the hip and knee are involved, hip arthroplasty should probably be done first. Regional anesthesia is preferable. Careful preoperative planning is essential because custom prostheses are often required. Small bone size, osteoporosis, and soft-tissue contractures make the surgery technically demanding. Skeletal immaturity is not an absolute contraindication to surgery. Component loosening is the most frequent late complication in hip arthroplasty. It is less common in condylar metal-to-plastic knee arthroplasty in which patellar complications predominate. Cementless arthroplasty has an evolving role in the patient with juvenile rheumatoid arthritis and, to date, is more often used in the hip than in the knee
33. Shakhbazian, I. E., Ulybina, O. V., Rozvadovskaia, O. S., Komarkova, N. N., Zholobova, E. S., and Sushkova, N. I. [Lesions of the large joints in systemic forms of juvenile rheumatoid arthritis] Porazhenie krupnykh sustavov pri sistemnykh formakh iuvenil'nogo revmatoidnogo artrita. Pediatriia. (11), 63-69. 1990.
    
34. White, P. H. Growth abnormalities in children with juvenile rheumatoid arthritis. Clin.Orthop. (259), 46-50. 1990.
    Department of Pediatric Rheumatology, Children's National Medical Center, George Washington University, Washington, D.C. 20010.
    Notes: Growth abnormalities in juvenile rheumatoid arthritis can be divided into two groups: local and systemic. Local disorders of growth often result in increased bone length and bone age or in marked decreases in longitudinal growth due to immobilization, premature epiphyseal closure, or fusion. Common growth defects seen in the knee, hand, wrist, hip, spine, and jaw are discussed. Systemic growth delay is most commonly secondary to active disease or treatment with corticosteroids. Nutritional aspects such as decreased appetite, reduced caloric intake, metabolic caloric requirements greater than available intake, or lack of essential vitamins could be the cause for decreased weight and stature