surgical management
Last edited 10/2018
Methods include:
- tendon repair or transfer to prevent progressive deformity secondary to tendon rupture and joint instability
- reconstructive surgery for advanced joint destruction, instability and deformity
- synovectomy
- arthrodesis, osteotomy, joint replacement and excision arthroplasty are also used
Timing and referral for surgery
- offer to refer people with RA for an early specialist surgical opinion if
any of the following do not respond to optimal non-surgical management:
- persistent pain due to joint damage or other identifiable soft tissue cause
- worsening joint function
- progressive deformity
- persistent localised synovitis
- offer to refer people with any of the following complications for a specialist
surgical opinion before damage or deformity becomes irreversible:
- imminent or actual tendon rupture
- nerve compression (for example, carpal tunnel syndrome)
- stress fracture
- offer urgent combined medical and surgical management to people with RA who have suspected or proven septic arthritis (especially in a prosthetic joint)
- if a person with RA develops any symptoms or signs that suggest cervical
myelopathy :
- request an urgent MRI scan, and
- refer for a specialist surgical opinion
- do not let concerns about the long-term durability of prosthetic joints influence decisions to offer joint replacements to younger people with RA
Reference: