Surgical treatment of Still's disease (juvenile chronic arthritis)

We have carried out 433 operations on 268 patients suffering from Still's disease during the period 1959-1979, the average age of the patients being 21 years. A synovectomy of the knee was performed on 76 knees with a good result in 68%, while a similar operation on the elbows of 16 patients was more successful and 90% did well. Stapling of the knee in young children with genu valgum was carried out on 33 knees with a good correction in the great majority. Soft tissue operations were carried out with encouraging results on 24 hips and 9 knees, the patients having severe deformities of these joints. Reconstructive surgery was necessary in some patients with severe damage to their hips and knees, and we obtained good results in the great majority. Two hundred and forty eight total hip replacements have been carried out on 132 patients during the last 14 years and 84% have had a good result, but owing to the skeletal stunting frequently present a special small sized hip prosthesis had to be used. Knee replacement has been less satisfactory but was carried out on 40 knees in 28 patients and 55% had a good result. The main complications seen with these joint replacements have been due to infection or loosening. Multiple joint replacement has been carried out on 42 patients, 13 of which had both hips and knees replaced with 54% good results. Difficulties were experienced in anaesthetizing some patients owing to a stiff neck and jaw, but this was overcome by the use of Ketamine anaesthesia.