Surgical strategy in surgery of the lower limb in rheumatoid arthritis
One of the great triumphs of orthopaedic surgery in the past half century has been the reconstruction of the multiply affected lower limb in rheumatoid patients. Previously an inexorable deterioration was liable to occur, especially if one or both hips became involved and the end product was all too often a wheelchair or bed-bound patient. Today this should only occur in very few patients since in order to pre-empt such a disastrous outcome a whole armamentarium has now been evolved, comprising forefoot arthroplasty, various forms of hindfoot fusion, ankle arthrodesis and ankle arthroplasty, total knee and hip replacement. Nearly all these operations are of proven and durable efficacy, only ankle arthroplasty being in the relatively experimental development phase and even this operation is now proving much more promising and durable. If, however, programmes of reconstruction are to reach their full potential of success, it is very important for the rheumatoid surgeon to be constantly mindful of the natural history of lower limb involvement and to use this knowledge in the selection of the most appropriate operations. Moreover, their optimal timing is still a major challenge demanding wisdom and experience.
KeywordsRheumatoid Arthritis Subtalar Joint Erosive Disease Rheumatoid Patient Ankle Arthrodesis
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