Abstract
The hip joints are commonly affected in Juvenile Idiopathic Arthritis (JIA) in childhood. Common features are pain, subluxation, femoral anteversion, coxa valga, significant fixed flexion deformity and a true arthritis, with loss of articular cartilage principally from the femoral head but also the acetabulum.
In children with JIA, it is accepted that a medial soft tissue release of the hips, dividing adductor longus, adductor brevis and the ilio-psoas, is a useful tool in the management of significant hip joint involvement. The principal indication for surgery is the relief of pain, but other benefits are correction of fixed flexion deformity, restoration of articular cartilage, increased abduction of the hips and, in those children who are unable to walk, frequently a transition to the potential to walk. The procedure is nearly always performed bilaterally.
Our study aimed to document the restoration of articular cartilage at the hips following soft tissue release. It has been noted in the literature that there is regrowth of articular cartilage in the hip but there has been no true documentation of this and x-ray studies are unreliable as the elimination of fixed flexion deformity can prejudice accurate analysis of femoral head geometry on 2 –dimensional views.
We therefore carried out MRI scanning of the hips, immediately prior to the soft tissue release and 12–18 months post-operatively. In 10 consecutive patients analysed, scans demonstrated true articular cartilage regrowth in 8 cases.
We thus conclude that soft tissue release of the hips in JIA is a useful management tool, and may to some extent reverse the severe articular cartilage loss seen in these children. The next stage of our study is to analyse the articular cartilage at the time of subsequent hip arthroplasty to determine whether true hyaline cartilage is reformed or whether the reconstitute represents fibrocartilage.
The abstracts were prepared by Mr N. M. P. Clarke. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
