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Published online by Cambridge University Press: 12 January 2010
Despite markedly improved and more aggressive medical management, rheumatoid arthritis continues to be, for many, a progressive disease that ultimately leads to significant joint destruction. The primary indication for almost all surgical procedures remains pain relief, with functional improvement and prevention of deformity being lesser goals.
Common operative procedures include the following.
Arthroplasty
Primarily joint replacement, such as total hip, knee, shoulder, elbow, wrist and metacarpophalangeal joints, but occasionally other anomalies such as interpositional arthroplasty.
Arthrodesis
Joint fusion remains an excellent procedure in some areas, such as the wrist, interphalangeal joints, ankle, spine, and selected others in certain clinical situations.
Soft tissue procedures
Synovectomy, tenosynovectomy, carpal tunnel release, tendon transfers, and tendon repair all have roles in certain patients. These occasionally are prophylactic and may help alter the course of the disease.
In general, the surgical stress involved is related to the magnitude of the specific procedure. On occasion, multiple procedures may be carried out at one time if they aren't too substantial. For more significant interventions, such as revision arthroplasty, isolated procedures tend to be the standard approach. Most primary procedures, alone or in combination, do not require more than two to three hours of anesthesia. Complicated operations, of course, may demand more.
Procedures on the distal portions of the extremities (below the shoulder and hip) are generally done with tourniquet control, with blood loss being minimal. Although shoulder surgery is done without tourniquet control, the amount of bleeding is usually not excessive and transfusion is fairly uncommon.
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