rheumatoid%20arthritis
RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a systemic autoimmune rheumatic disorder of unknown etiology.
It is the most common form of inflammatory arthritis.
Patient usually complains of joint pain and/or swelling with morning stiffness that lasts for more than an hour.

Goals of treatment are clinical & radiological remission of disease and to reduce functional limitations & permanent joint damage.

Surgical Intervention

  • Surgical referral should be done before damage or deformity becomes irreversible in the following cases:
    • Actual or imminent tendon rupture
    • Nerve compression (eg Carpal tunnel syndrome)
    • Stress fractures

Indications

  • Unacceptable levels of pain
  • Persistent localized synovitis
  • Worsening joint function (ie instability or severe loss of range of joint motion)
  • Progressive deformity

Benefits

  • Deformity prevention
  • Joint function improvement &/or prevention of further deterioration
  • Pain relief

Surgical Procedures

Arthrodesis

  • Advantage: Provides stability & relief from pain
  • Indication: Young, active patients with severe unilateral joint involvement
  • Contraindication: Involvement of contralateral hip

Arthroplasty

  • Total knee arthroplasty is the surgical treatment of choice in most patients with rheumatoid arthritis affecting the knees
    • Relieves pain & may increase range of motion in patients with advanced RA who did not benefit from synovectomy
  • Indication: Patients with rheumatoid arthritis class III or class IV without multiple joint, ipsilateral hip or ankle or contralateral or both knee involvement
  • Complications:
    • Deep wound infection
    • Involves multiple joints limiting rehabilitation
    • Poor tissue healing
    • Severe flexion contracture, joint laxity & osteopenia
  • Complications may be minimized by utilization of antibiotic-containing bone cement & optimize preoperative nutrition

Synovectomy

  • Indicated in cases of inappropriate response to pharmacologic management after 6 months
  • Disease should be limited to synovial membrane but may involve little cartilage or bone or if any narrowing of joint space as seen on radiograph
  • High failure rate was observed in advanced stages of rheumatic arthritis if late synovectomy is done
  • Arthroscopic knee synovectomy controls synovitis, improvement in pain & preserves existing range of motion
  • Advantages of arthroscopic synovectomy:
    • Minimal incision
    • Complete synovial resection
    • Decreased incidence of infection, hemarthrosis
    • Increased or maintained range of motion
    • Intact quadriceps muscle
    • Lesser postoperative physical therapy
    • Cost-effective with high patient acceptance

Other Procedures

  • Carpal tunnel release
  • Cervical C1-C2 fusion
  • Finger small joints fusion/arthroplasty
  • Joint replacement
  • Tendon reconstruction
  • Tendon transfers
  • Total joint arthroplasty
  • Tenosynovectomy
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