[Multiple joint replacement in chronic rheumatoid arthritis: results, indications]

Rheumatoid arthritis, steadily progressive and affecting many joints, is a real challenge for the orthopaedic surgeon. Thorough assessment and long-term planning to maximize overall performance requires clear orthopaedic thinking based on wide experience. The final aim is to enable the patients to walk and be independent. Over the last 30 years, the surgery of the rheumatic diseases has become a well-established specialty within orthopaedic surgery. Open synovectomy still has a place. In badly damaged joints, however, only prosthetic joint replacement has a fair chance. Total hip replacement is now a common procedure. Yet many problems regarding long-term performance remain unclear. This is even more pertinent for total knee replacement. Operations on the upper limbs must enable the patient to become less dependent of other people's help. Artificial shoulder joints have become more popular, and elbow joint replacement has been a particularly important field at the Wilhelm Schulthess Clinic. Multiple joint replacement is often necessary and can improve the quality of life for these badly stricken patients.