[Surgical possibilities in orthopedic rheumatology]

Surgery has been a mainstay in the treatment of rheumatic conditions. Basically, its effect is limited to the site involved. Reconstruction of a damaged component of the locomotor system, however, may also relieve other components, and thus improve their function. Usually the prescribed drug treatment and physiotherapy must be continued, although the rehabilitation of individual, particularly severely affected joints may result in reduced drug intake. Surgery is indicated in the early stages, when isolated joint inflammations remain unchanged for more than half a year in spite of intensive physical and drug treatment. Best results have been achieved with preventive procedures (synovectomy, tenosynovectomy) carried out before joint alterations become evident in the x-ray. These procedures can also be performed in advanced stages, usually together with reconstructive measures. These patients, however, must expect some discomfort to remain, because of the irreversible joint damage already incurred. The operations selected for advanced cases include corrective osteotomies, resection arthroplasties and arthrodeses. To date, satisfactory long-term results of allo-arthroplastic joint replacements are only assured in terms of hip and, with reservations, knee prostheses.