Notities
Diavoorstelling
Overzicht
1
Juvenile idiopathic arthritis
  • Surgical treatment of the growing child


  • Urban Rydholm
  • Department of Orthopaedics, University Hospital in Lund
2
Types of disease (JIA)
  • Systemic
  • Polyarticular
  • Oligoarticular
  • JAS
  • Psoriatic, bowel, scleroderma, JDM, MCTD…..
3
Primary joint affection
4
 
5
Differential diagnoses in monoarticular disease
  • Hip
  • Coxitis simplex
  • (transient synovitis)
  • Mb Perthes
  • Physiolysis
  • Knee
  • Osteochondritis dissecans
  • Chondromalacia patellae
  • Meniscus injuries
  • Discoid lateral meniscus


6
Incidence – prevalence in Sweden
  • Incidence
  • 15/100 000/year


  • Prevalence (0-15) years
  • ~ 2000 children
7
Intra-articular corticosteroids
8
Intravenous regional steroids
9
Growth disturbances
10
Micrognathia (anaesthesiological problem)
11
Cervical spine
  • Anchylosis
12
Early synovitis and pannus formation
13
Severe arthritic destruction
14
JIA – surgery in Sweden
15
 
16
Surgical Menue
  • Arthroscopy
  • Synovectomy
  • Tenosynovectomy
  • Soft tissue release
  • Neurolysis


  • Physiodesis
  • Core decompression
  • Osteotomy
  • Arthrodesis
  • Joint replacement
17
JIA-surgery in Lund
18
Synovectomy in JIA
19
Arthroplasty vs synovecomy
20
Shoulder
21
Shoulder - synovectomy
22
Shoulder - typical radiograph
23
Shoulder - arthroplasty
24
Elbow
25
Elbow – typical radiographs
26
Elbow - growth disturbance
27
Elbow - synovecomy
28
Elbow - arthroplasty
29
Elbow - custom made implants
30
Hip
31
 
32
Arterial supply to the femoral head
33
Hip joint - compliance
34
Intra articular pressure
35
Sonography of the hip
36
Juvenile hip arthritis
37
Special features of the hip in JIA
38
Typical radiographs
39
Spontaneous anchylosis followed by femoral neck fatigue fractures
40
Don’t forget the possibility of septic arthritis!
41
Core decompression
42
Intertrochanteric osteotomy of the femur
43
Hip prostheses - JIA
44
Cemented hip arthroplasty
45
”Inverse hybrid” hip prosthesis
46
Hybrid (ceramic-ceramic coupling) prosthesis
47
Hip prostheses in JIA – problems as time passes
48
Knee
49
Knee radiographs –
the importance of sidewise comparison
50
Posterior subluxation of the tibia
51
Knee splint for flexion contracture
52
Flexion contracture of the knee
53
Longstanding synovitis of the knee joint
54
Physeodesis (temporary staples)
55
Stapling of the knee –
clinical result
56
Leg length discrepancy –       different developments with age
57
Supracondylar varus femoral ostetomy
58
Knee arthroplasty –
growth disturbance
59
Knee arthroplasty -
extensor insufficiency
60
Peroneal nerve
61
Knee arthroplasty
62
Foot
63
Synovial tissues of the foot
64
Ankle
65
Ankle
66
Ankle arthrodesis
67
Necrosis of the talus (SLE)
68
Hindfoot
69
Varus deformity of the hindfoot is very common
70
Varus and valgus deformities of the hindfeet
71
Varus deformity of the hindfoot is difficult to treat!
72
Calcaneus osteotomy for hindfoot deformity
73
Correction of varus deformity with external fixator
74
Talo-navicular joint arthritis
75
Subtalar arthrodeses
76
Forefoot
77
Hallux valgus and MTP-joint subluxation
78
Thank you!