Full Description
Over a decade has passed since the publication of the First Edition; we have yet to understand the pathogenesis of rheumatoid arthritis and there is still no cure. A wide range of developments in techniques, materials, imaging and understanding of biological processes justify this rewrite. Above all, the experience of many colleagues worldwide with commitments to a particular anatomical or technical area has led to a more balanced and refined approach to the problems of rheumatoid surgery. It has also highlighted areas where we need radically new solutions. The two additional authors, apart from their relative youth, bring expertise in their respective fields: Steve Copeland, on the shoulder and Jo Edwards on the mechanisms of tissue damage and the rationale of medical measures. We are conscious of the importance of communication between orthopaedic colleagues worldwide and the need to use a language shared with rheumatologists and histopathologists. We consider it is for the surgeon to know more of this disease than the narrow confines of surgical technique. We are doctors with a special interest in rheumatoid arthritis and we aim to maintain the broader view rather than be confined by the limitations of over specialisation. Although joint replacement is at present a major weapon for the relief of suffering we appreciate that it is an unphysiological procedure and there are other directions for progress.
Contents
1 General Considerations.- The Route to the Surgeon.- Diagnosis and Assessment.- Course of the Disease.- Communication.- Assessment of the Results of Surgery.- Bacterial Infection and Septic Arthritis.- Corticosteroids.- Bed Rest.- Psychological Factors.- Physiotherapy.- Surgical Trends.- 2 Aetiology and Pathology.- Aetiology.- The Causes of Rheumatoid Arthritis.- Disease Mechanisms.- The Nature of the Connective Tissue Lesion.- A General Disease Mechanism.- Targets for Drug Action.- Rationale for Synovectomy.- Synovitis Following Arthroplasty.- Synovial Biopsy.- Synovial Fluid Examination.- Lesions in Other Tissues.- Seronegative Spondarthropathies.- Systemic Lupus Erythematosus.- 3 Selection.- Assessment of the Specific Problem.- Surgical Selection.- Which Operation?.- How Soon?.- What Order?.- How Many?.- Recording a Decision.- 4 The Link with Medical Management.- The Physician's Plan of Care.- Systemic Features and Associated Medical Problems.- Rheumatological Emergencies.- Children with Rheumatic Disease.- Summary.- 5 Perioperative Care.- Preoperative Assessment.- Preoperative Investigation.- The Immediate Preoperative Period.- Drugs in the Perioperative Period.- Care During Surgery.- Postoperative Care.- 6 Synovectomy.- Damage Produced by Synovitis.- Treatments of Synovitis and Synovial Hypertrophy.- Osteotomy.- Surgical Synovectomy.- Recurrent Synovitis after Synovectomy.- Children.- Seronegative Arthropathies.- Conclusion.- 7 Osteotomy.- Jaw.- Action of Osteotomy.- Operative Technique.- Total Replacement or Osteotomy?.- 8 Arthroplasty.- Excision Arthroplasty.- Excision Arthroplasty Following Failed Total Joint Replacement.- Soft Tissue Interposition Arthroplasty.- Replacement by Massive Cadaveric Grafts.- Replacement by Prosthesis.- Failure of Total JointReplacement.- Surgery After Failure of a Prosthesis.- 9 Arthrodesis.- Cervical Spine.- Shoulder.- Elbow.- Wrist.- Carpometacarpal Joint of the Thumb.- Metacarpophalangeal Joint of the Thumb.- Interphalangeal Joint of the Thumb.- Proximal Interphalangeal Joints of the Fingers.- Distal Interphalangeal Joints of the Fingers.- The Hip.- The Knee.- The Ankle.- Subtaloid Joint.- Midtarsal Joints.- Metatarsophalangeal Joints.- Proximal Interphalangeal Joints of the Toes.- Distal Interphalangeal Joints of the Toes.- 10 The Spine.- Pathology.- Clinical Features.- Imaging of the Rheumatoid Spine.- Conservative Management.- Psychological Support.- Surgical Management.- Dorsal and Lumbar Spine.- Ankylosing Spondylitis.- 11 The Shoulder.- Progression of Joint Damage.- Rotator Cuff Impingement.- Acromioclavicular Joint.- Sternoclavicular Joint.- Glenohumeral Joint.- Conclusion.- 12 The Elbow.- Extra-articular Disease.- Intra-articular Disease.- Arthrodesis.- Arthroplasty.- Conclusion.- 13 The Wrist.- The Carpal Tunnel.- The Long Flexor Tendons.- The Long Extensor Tendons.- De Quervain's Disease.- Deformity at the Wrist.- Surgical Options.- 14 The Hand.- Assessment and Priorities in Rheumatoid Hand Surgery.- Patterns of Disease.- Soft Tissue Swellings.- Synovitis.- Genesis of Joint Deformity.- Arthroplasty in the Hand.- Arthrodesis.- The Rheumatoid Thumb.- The Jaccoud Hand.- Operative Techniques.- Conclusion.- 15 The Hip.- Surgical Priority.- Synovectomy.- Adductor Tenotomy.- Osteotomy.- Excision Arthroplasty.- Hemiarthroplasty.- Total Hip Replacement.- 16 The Knee.- Examination.- Conservative Treatment.- Operative Treatment.- Conclusion.- 17 The Ankle and Foot.- Clinical Assessement.- Aims of Surgery.- Perioperative "Tips".- Ankle and Hindfoot.- Mid-foot.- Forefoot.- ToeDeformities.- Vascular and Neurological Problems.- 18 The Rheumatoid in Society.- Prevalence.- Aids to Daily Living.- Diet.- Work.- Mobility.- Recreation.- Sexual Problems.- Planned Motherhood.- The More Disabled Person.- Conclusion.- Author Index.
