Synovectomy of the knee in juvenile rheumtoid arthritis.

Juvenile rheumatoid arthritis or Still’s disease, although comparatively rare, is a potentially crippling disease. Laaksonen (1966) estimated that in Finland the incidence in children under fifteen is six to eight per 100,000 per year. Brattstrom and Sundberg (1965) stated that in 60 to 70 per cent the knees are affected. With good conservative treatment much disability can be prevented but many cases do not fully respond. Thus in Laaksonen’s series nearly 30 per cent of patients were left with severe disability. Although synovectomy of the knee is now an established method of treatment in adult rheumatoid arthritis, opinion has been divided as to its value in children, and several arguments have been used against it. It has been suggested that it is difficult to obtain the child’s cooperation in moving the joint after the operation, and early movement is of course essential in regaining full movement. It has also been feared that synovectomy in children might damage the growth cartilage or blood supply to the epiphysis and so disturb growth of the limb. Another question was whether the surgical treatment might not exacerbate the rheumatoid state. Jakubowski and Ruszczynska (1967) suggested that early synovectomy had a prophylactic value, but gave no details of their results. Jani and Waigand (1971) reported twelve synovectomies of the knee performed over a period of three years i1 nine children, of whom four were observed for over two years. They reported three unsatisfactory results, all in children under five who had less movement after operation, and therefore recommended restraint