Orthopedic therapy in rheumatic diseases

The treatment of rheumatic disease requires an interdisciplinary approach in which the orthopedic surgeon is also involved. His contribution includes both conservative and operative procedures. Early synovectomy applied to joints and tendons is considered a preventive measure. Arthroscopic synovectomy belongs in the hands of an experienced operator. Joints that are not directly involved in weight-bearing can be treated by means of arthroplastic procedures, provided the cooperation of the patient is ensured. Arthrodesis is used preferentially to treat articular destruction of the ankle joint, the metacarpophalangeal joint of the thumb and the middle joints of the finger. Osteoporosis represents a relative contraindication. The treatment of rheumatic diseases of the joints using endoprostheses produces good primary results. The rate of loosening is not significantly increased, but late infection is somewhat higher than in other forms of articular disease.