[Role of surgery in the treatment of juvenile chronic arthritis]

The orthopaedic surgeon intervenes in the diagnosis by performing open surgical or arthroscopic biopsies, which entail the main risk of joint stiffening; to treat the disease locally at the inflammatory stage either by synoviorthesis or by tenosynovectomy or open or arthroscopic synovectomy; in case of sequela, when the orthopaedic surgeon may propose surgery aiming to recuperate function of the limbs or the spine. Such surgery includes soft tissue (tenocapsulotomy), osteotomy, arthrodesis, and prosthetic arthroplasty. At the spine, we are faced with three problems: cervical instability, spinal fractures and scolioses. Only teams experienced in heavy paediatric orthopaedic surgery of this type should attempt surgery in chronic inflammatory rheumatism.