ROLE OF SURGERY IN RA


Traditionally arthritis had been managed by orthopaedic surgeons. Today they are not required to spend time on medical management and can concentrate on surgical treatment which has progressed by leaps and bounds.
Common surgical interventions in RA are :

1. Synovectomy
2. Arthroplasty
3. Arthrodesis
4. Tendon repair
5. Surgery for carpal tunnel syndrome
6. Surgery for atlanto-axial dislocation.

The role and place of each is described briefly

1. Synovectomy means (surgical) removal of the diseased (inflammed) synovium. This was once a popular / common therapeutic procedure for the treatment of RA. Today, it is indicated only for persistent synovitis in a single or few joints, after adequate drug therapy. Synovectomy is not a curative intervention. For best benefit it should be performed before joint damage has started.

2. Arthroplasty – This means replacement of damaged joint parts with artificial material. This surgical procedure is reserved for patients who have unremitting joint pain and / or disability as a result of joint damage. The procedure has a very high success rate (95% +) in experienced hands. The most commonly operated joints are knee and hip. Shoulder, elbow, finger joint replacement surgery is also in vogue. When indicated joint replacement is the best option for the patient. The main constraint is cost. Failure rate is < 5%. Infection is rare but an important complication.

3. Arthrodesis – converts a mobile joint into a fixed joint. It relieves pain at the expense of mobility and the associated handicap. It is therefore the option / choice of the last resort.

4. Tendon repair – The most common tendons to rupture are those concerned with finger movement (extension), leading to what is popularly called “dropped fingers”. This can be repaired effectively.

5. Surgery for carpal tunnel syndrome – The median nerve which innervates thumb, index, middle and part of ring finger gets compressed. This causes tingling, numbness and pain followed later by muscle weakness. Surgery is indicated when other measures like rest with splints and local steroid injection(s) fail to relieve the condition Surgery for atlanto-axial dislocation, this condition needs surgery, that is stabilisation of the atlanto-axial joint. The indication for surgery is presence of neurologic compromise.