Surgical rehabilitation

There is hardly any other disorder where the possibility of replacing destroyed joints by artificial ones has transformed the functional outcome so decisively as in rheumatoid arthritis. The advances achieved in surgery may even be regarded as the most important result of any research on rheumatoid arthritis as published in recent years. Arthroplastics account for almost half of all interventions in our own statistics which cover almost 6000 operations on patients with this disease. Surgical synovectomies account for more than 40 per cent, and various other techniques are used in only 10 per cent of operations. Indications and contra-indications are discussed first in a more general way, and the need for close collaboration of family doctor, rheumatologist, orthopaedic surgeon and highly qualified therapeutic staff is emphasized. In the following sections the most rewarding methods used for rehabilitation of the upper limbs are described, including pre- and post-surgical management as well as the results to be expected. Subsequently our standard programme for the surgical rehabilitation of the affected joints of the lower limbs is presented. Special reference is made to a new technique for the fixation of the arthroplasty in cases of rheumatoid acetabular protrusion.