Background Juvenile idiopathic arthritis (JIA) is one of the most serious chronic diseases in children. The osteoarthritis degenerative destructive changes occur in all components of the hip. Basic of pathogenetic approach to conservative treatment of JIA is the appointment of immunosuppressive therapy. The most effective operative treatment of hip osteoarthritis is now a total hip replacement (THR) that allows to quickly restore the length of the reference and the function of the affected limb.
Objectives To implement the functional recovery and improve the quality of life of adolescents with severe hip osteoarthritis against JIA.
Methods The study is based on an analysis of 32 patients with lesions of the hip against the JIA, operated in trauma and orthopedic department Science Center of children health from 2008 to 2012. Of these 4 patients carried a one-sided hip replacement, 28 - two-sided. All patients conformed ILAR criteria for juvenile idiopathic arthritis. All patients on the JIA were receiving immunosuppressive and biological therapy in rheumatology department. On the background of this therapy succeeded in reducing disease activity, which enabled a THR. Patient’s age was 13 - 18 years (11 male and 21 female). During arthroplasty were used in excess of the small types of leg prosthesis adapted to the size of teenager’s femoral canal. The components of the endoprosthesis of the acetabulum was adjusted to the size and anatomical and physiological relationships altered the hip joints. We used the hard liners, ceramic pottery, less wear and tear which can reduce the severity of osteolysis artificial joint. The clinical results were evaluated using the Harris Hip Score and CHAQ.
Results After completion of the rehabilitation of patients significantly increased range of motion in the hip joints. The Harris Hip Score increased from 52±4 score before operation to 85±5 score through 1 year after THR (p<0,001), NHAQ – from 2,4 (preoperative) to 0,8 (p<0,003) 1 year after THR, indicating that the effectiveness of the comprehensive treatment and significant improvements in quality of life. Analysis of X-ray images during follow-up, demonstrated good positioning of the implant components. Results of surgery: 30 patients had good results, 2-satisfied. There was one complication in a patient with a reduction in bone mineral density (Z-score preoperative was -8): split the proximal femur in relation to what has been imposed around the seam by metal wire. Long term examination of hip endoprothesis in 95% showed positive results.
Conclusions Total hip replacement for severe hip osteoarthritis is an effective method of surgical treatment allows to restore functional status of patients and increases the quality of their life. The use of modern ultra implants significantly reduces the duration of trauma while operations that expands the indications for this type of intervention in young patients.
Disclosure of Interest None Declared
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