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.