J. M. Wilkinson, , D. Stanley and C. J. M. Getty
Department of Orthopaedics, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
Rheumatoid arthritis (RA) is the most common inflammatory disease, affecting 13% of the adult population. Multiple joint involvement, systemic co-morbidity, and polypharmacy including immuno-modulatory drugs, present the surgeon with significant challenges. Surgical management of RA patients requires a multi-disciplinary approach. Pre-operative management includes assessment of all joints involved, identification of the correct surgical sequence, and evaluation of medical fitness for anaesthesia and surgery. Disease modifying agents should be continued peri-operatively together with adequate replacement therapy in patients taking corticosteroids. Peri-operative care also includes prophylaxis for infective and gastrointestinal complications. Gentle handling of delicate soft tissue and bone is required intraoperatively. Thin skin and pressure areas need support and padding. Successful post-operative rehabilitation involves early mobilisation, input from occupational and physiotherapists, and adequate provision of domestic aftercare.
Current Orthopaedics Volume 18, Issue 5 , October 2004, Pages 357-370.