Surgical management of the hip in juvenile chronic arthritis

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.