Håkan Brattström

Arthroscopy of the Hip in Juvenile Chronic Arthritis

Summary: After distension of the hip joint with physiological saline followed by traction, hip arthroscopy was performed in 13 patients (15 hips) with juvenile chronic arthritis. Arthroscopy gave better information about the cartilage than the roentgenograms and gave the same information about the synovial membrane as the operation. This diagnostic procedure should be performed early in the course of hip disability.

Atlanto-Axial Fusion in Rheumatoid Arthritis A New Method of Fixation with Wire and Bone Cement

Twenty-eight occipito-cervical fusions performed over the past 4 years in patients with rheumatoid arthritis are discussed. All of the patients with one exception had signs of neurological involvement preoperatively due to pressure on occipital nerve roots, spinal cord and/or vertebral arteries. A surgical technique using wire, pin and bone cement and permitting early mobilization without external fixation was used and is described in detail. The clinical results were excellent in 21 cases with an additional five patients showing improvement. One patient did not benefit from surgery and one had no symptoms preoperatively. The results are encouraging and the possibility of early mobilization (the day after surgery) is of the utmost importance for this group of patients.

Sexual difficulties and total hip replacement in rheumatoid arthritis.

Fifty-three patients with rheumatoid arthritis were interviewed by questionnaire. All the patients had undergone total hip replacement and were married at the time of operation. They were asked if they had had sexual difficulties because of hip pain or stiffness and if the hip operation had in any way alleviated these problems. Forty-four of the 53 patients answered the questionnaire. Twenty-eight patients had had sexual problems which they attributed to hip symptoms. Following total hip replacement the hips of 27 patients were no longer considered to be the cause of sexual difficulties, but in 10 of those patients other problems still rendered sexual life difficult.

Resection of the Metatarsophalangeal Joints in Rheumatoid Arthritis

(1970). Resection of the Metatarsophalangeal Joints in Rheumatoid Arthritis. Acta Orthopaedica Scandinavica: Vol. 41, No. 2, pp. 213-224.

Stapling of the Knee in Juvenile Chronic Arthritis

Stapling of the distal medial femur and/or proximal tibia was performed in 17 juvenile chronic arthritic knees with progressive valgus deformity. Correction with −5° of residual valgus deformity was obtained in all but two knees. Five knees were stapled for correction of progressive leg length discrepancy. Equality of leg length was obtained in two, slight undercorrection in two, and overcorrection in one patient. Careful supervision of the patient is recommended because of difficulties in using existing methods for growth prediction. The rate of correction differs considerably between patients because of differences in age, type of disease, and medical treatment.

Total Hip Replacement in Ankylosing Spondylitis

Eighteen total hip replacements were performed in 10 patients with ankylosing spondylitis. The mean observation time was 3.8 years. Seven hips had been operated on before total hip replacement (THR); 6 Were ankylotic before THR. The results as regards pain relief and increased walking distance were good. All hips improved in mobility after THR and this improvement was maintained during the observation time. Six of the 10 patients went back to full-time work. The differences between patients with ankylosing spondylitis and rheumatoid arthritis, as regards indications for and rehabilitation after THR, are discussed.

Total Hip Replacement in Juvenile Chronic Arthritis

Fifty total hip replacements in 33 patients with juvenile chronic arthritis were performed over a 10-year period with good pain reduction, increased hip motion but only a moderate increase in walking capacity. The average age at operation was 26 years and the average follow-up time 77 months. Six hips (patients) have been reoperated, one for infection, one for suspected infection and four due to mechanical loosening. Loosening was revealed radiographically in 10 hips at follow-up. Lack of cement cover and varus position was the main reason for loosening of the femoral stem. Considering the high loosening rate it is probable that at least one revision arthroplasty will be necessary in the future.

Seventy-four Attenborough knee replacements for rheumatoid arthritis: A clinical and radiographic study

Seventy-four Attenborough total knee replacements in patients with severe classical rheumatoid arthritis were followed for 2-5 years. The preoperative radiograms were evaluated according to two different scoring systems. At follow-up, radiographic whole leg examinations were performed. Mean malalignment was 7 degrees. The overall results were not encouraging with definite failure in eight knees and probable failure in another 21 knees. Failure was significantly correlated with postoperative malalignment.

Soft tissue release for knee flexion contracture in juvenile chronic arthritis.

Summary: Twenty-nine soft tissue releases for knee flexion contracture were performed in 23 children 2-15 years of age with juvenile chronic arthritis. The average duration of knee joint involvement was 4.6 years (range 1-11 years), and the mean age at operation was 8.6 years. Twenty-one of the 29 knee joints had a fixed flexion deformity exceeding 15° preoperatively. Twentyfive knees were followed up for a mean period of 3.9 years (range 1-8 years), at which time only eight knees had a flexion deformity exceeding 15°. There was a lasting effect of the release operations, and no significant complications were encountered. It is concluded that the procedure is worthwhile

Soft tissue release of the hip in juvenile chronic arthritis.

Adductor and/or subspinal tenotomies were performed on 17 patients (25 hips) with longstanding juvenile chronic arthritis and hip disability. The flexion contracture decreased after surgery from 28 to 18 degrees but had increased to the preoperative level by an average follow-up time of 48 months. The adductor contractures followed the same pattern. All but 3 of the patients were dissatisfied with the relatively small gain and the short-lasting effect of the operation. Knee contractures and insufficient release are probably some of the reasons for the poor results. A more extensive release is recommended and in the case of hip pain combined with synovectomy.