Treatment of knee flexion contracture in patients with chronic juvenile arthritis--a case report

Abstract

INTRODUCTION: Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. CASE REPORT: A 23-year-old female patient with chronic juvenile arthritis since the age of one was admitted for treatment of flexion contractures in both knees, muscle hypotrophy, loss of strength and gait disability. The patient underwent arthroscopic synovectomy. The operation was first performed on the right and after 3 mouths on the left knee. The preoperative range of motion in the right knee was 30 degrees - 70 degrees and in the left 40 degrees - 80 degrees. The patient underwent intensive physical therapy to reduce postoperative swelling of knees and firstly passive and then active kinesitherapy. Nine months after the first surgery and six months after the second, the range of motion in the right knee was 0 degrees - 100 degrees and in the left 0 degrees - 105 degrees. The strength of tested muscles was increased and gait was improved. CONCLUSION: Management and rehabilitation of patients with chronic juvenile arthritis include maintenance or improvement in position and function of joints that is achieved with synovectomy. The results depend on combined interdisciplinary rehabilitation, well-experienced staff and pre- and post-operative physiotherapy as well as kinesitherapy. Arthroscopic synovectomy has many advantages and we believe that it was a better solution than open capsulosynovectomy in this patient with chronic juvenile arthritis of the knee.