SURGICAL MANAGEMENT OF THE HIP IN JUVENILE CHRONIC ARTHRITIS

The hip joint is the most important joint as far as surgicalmanagement of JCA is concerned. Approximately a third of childrenwill develop hip involvement, leading to pain and deformity.A wide spectrum of hip joint abnormalities may occur, beingthe result of either under-development or over-development ofthe bones and erosive change secondary to the synovitis. Forthe acutely irritable hip with no fixed deformity an intra-articularinjection of Triamcinolone Hexacetonide may be beneficial. Forthose hips with a fixed deformity, resulting in functional impairmentin children prior to the closure of the proximal femoral capitalepiphysis, a soft tissue release of selected muscles aroundthe hip joint can correct deformity and improve function. Forthe painful destroyed hip joint, total joint replacement isindicated. Cemented hip replacements have been shown to havea high incidence of loosening in this patient group and considerationis being given to the use of customized uncemented femoral components. KEY WORDS: Juvenile chronic arthritis, Soft tissue release, Hip joint replacement