surgical management

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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:

Last edited 10/2018

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