Total joint replacement for severe rheumatoid arthritis
- Michael H Weisman, MD
Michael H Weisman, MD
- Director, Division of Rheumatology
- Professor of Medicine
- Cedars-Sinai Medical Center
- Renee Z Rinaldi, MD
Renee Z Rinaldi, MD
- Associate Clinical Professor of Medicine
- The David Geffen School of Medicine, UCLA
- Section Editor
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
Rheumatoid arthritis (RA) is a chronic, progressive disorder in many patients. Despite therapy with disease-modifying antirheumatic drugs (DMARDS), including biologic agents, joint erosion and destruction can develop over time. (See "General principles of management of rheumatoid arthritis in adults".)
The major symptom of joint destruction is pain. With further progression of the arthritis, there are signs of loss of motion, diminution in motor strength, and ultimately decline in function. (See "Evaluation and medical management of end-stage rheumatoid arthritis".)
This topic will review the surgical indications, procedures, management approach, and complications of total joint replacement (TJR) in patients with severe RA. Overviews of total hip and knee arthroplasty and their complications, as well as the perioperative management of patients with rheumatic diseases, are presented elsewhere. (See "Total hip arthroplasty" and "Total knee arthroplasty" and "Complications of total hip arthroplasty" and "Complications of total knee arthroplasty" and "Preoperative evaluation and perioperative management of patients with rheumatic diseases".)
FREQUENCY OF JOINT REPLACEMENT
The advent of total joint replacement (TJR) has been considered to be a major breakthrough and an important therapeutic option in the management of rheumatoid arthritis (RA). A 23-year, prospective, longitudinal, observational study (from a single referral center) of TJR and its predictors in 1600 patients with RA followed between 1974 and 1997 from the time of diagnosis revealed the following :
●Approximately 25 percent underwent TJR.
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- FREQUENCY OF JOINT REPLACEMENT
- INDICATIONS AND SURGICAL OPTIONS
- TOTAL JOINT ARTHROPLASTY
- Preoperative evaluation
- Management of antirheumatic drug therapy
- Surgical priorities
- Total hip arthroplasty
- Total knee arthroplasty
- Total shoulder arthroplasty
- Total elbow arthroplasty
- Total wrist arthroplasty
- Total ankle arthroplasty
- Total metacarpophalangeal arthroplasty
- Implant loosening and failure and cobalt toxicity
- Hip dislocation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS