Rheumatoid arthritis (RA) is a chronic, systemic disease of the small joints that invariably damages the synovium. Its prevalence rate is 0.5% of the world population (1).
Surgery in Rheumatoid Arthritis is resorted to when there are fixed bony deformities and movement at the joint is jeopardized. The multifaceted medical line of treatment provides no curative reassurance. The modern surgical techniques aid in correcting the damage to the joints and this may provide relief in pain, remodeling of the deformed joint and enhancing the joint function (2).
It is critical to decide- when to resort to surgery and whether the surgery will be helpful in alleviating the pain. The selection criteria include presence of structural damage to a joint or the tissues around it. Also, the surgery should be carried out at the optimum time; a delay in surgery can lead to lesser success rates (3).
TYPES OF SURGERY USED IN RA (2)-
The type of surgery will vary depending on the deformity and the area of involvement; whether joint, bones or connective tissue. Since the advent of minimally invasive surgery, Arthroscopic surgery has gained pace. Radiosynoviorthesis (RSO) is also a minimally invasive procedure with the means of radiation, the inflammatory changes are alleviated (2).
Synovectomy– it deals with the resection of the joint lining called synovium. RA pathogenesis involved hypertrophy of the synovium which encroaches joint related structures. An inflamed synovium is responsible for erosion and damage to the cartilage and the bone. Synovectomy is done to limit the damage. In case of joint pain and swelling recalcitrant to medical line of treatment, synovectomy is considered. RA in Knee, Wrist, Shoulder, Finger, Elbow and Ankle are considered for synovectomy
Tendon repair– tendons are vulnerable to rupture owing to the presence of swelling and inflammation of joints. It is common in wrist and hand. Tendon repair involves using tendons from other area of the body to do end to end and end to side anastomosis.
Osteotomy- RA causes erosions of the joint margins and sclerosis of the bone , deformity further loss of joint function. Osteotomy involves resection of a section of bone and the use of screws or other hardware to remodel the bone so that it can grow together. This establishes joint alignment and mobility, resolves functional problems and reduces the pain. Post Osteotomy it takes 6 to 12 months to recover.
Arthrodesis- It incorporated fusion of bones to cause permanent immobilization of a joint. It is performed in cases where the stability of the joint is lost. The joint is positioned in the most functional position and locked with the help of screws and rods. Arthrodesis lends reduction in pain and preserves the remaining joint function. It is useful in the wrist, first toe, hindfoot, ankle, and thumb.
Arthroplasty– also termed as joint replacement is the ultimate surgery when there is complete loss of cartilage and there is global destruction of the joint leading to very restricted movement and severe pain. Replacement of damaged joints achieve both reduction of pain and establishment of joint movement. Since a decade arthroplasty are performed with very high success rates. The surgeon can opt for either artificial (prosthetic) or natural components for the replacement. The major concern is the possibility of infection at the site of surgery. The second concern is possibility of nerve damage during the procedure or formation of blood clots. The life span of the prosthesis is around 10 to 15 years.