Surgical Treatment of Rheumatoid Arthritis

Kim, Jung Man; Kwak, Woon Sang

Abstract

The result of forty cases of rheumatoid arthritis according to New York criterion, who underwent multiple operations(up to 10) in multiple joints hetween 1983 and 1986 were evaluated in 3 years and 8 months in average(range; 18 months to 5 years 2 months)postoperatively. The joints operated upon were knee, ankle, shoulder, elbow, wrist and finger joints. The surgery performed were 65 arthroscopic synovectomies, 17 total joint replacement(16 knees and 1 elbow) and 7 arthrodesis(1 knee, 1 ankle and 5 wrists). There were 10 males and 30 females, 27 "clsssic" and 13 "definite" rheumatoid arthritis according to the classification of American Rheumatism Association.Functional capacity of the patient was graded as I, II,III and IV according to the ARA. The final clinical results were graded as "excellent", "good", "fair" and "poor" according to the modified citeria of Sledge et al(20). The relationship between number of cases of recurred synovitis and various factors such as sex, classification according to the ARA, number of joints involoved and extent of synovectomy in the knee joint was analyzed statistically with chi-square test of the contingency table.The results are as follows; 1. The final results were 22 "excellent"(55.0%), 16 "good"(40.0%) (altogether 95% of cases were satisfactory) and 2 fair (5.2%), but there was no "poor" result. 2. All cases showed functional improvement, the commonest mode of improvement being from preoperative grade II to postoperative grade I(19 out of 40 cases, 47.5%). 3. There were 9 cases of recurrence of synovitis following arthroscopic synovectomy(22.5 %). They were controlled by medication in 2 cases, and by reoperation in 5 cases (resynovectomy ; 3, joint replacement; 1, arthrodesis ; 1). 4. The factors such as sex, classification and number of joints involved were not significantly correlated c the recurrence rate although there was a tendency of frequent recurrences in cases of female, classic RA and multiple joint involovement (P>0.05). 5. In the knee joint there was significantly less recurrence rate in total synovectomy cases (1/20, S.0%) than in anterior synovectomy cases (7/22, 31.8%) (P<0.01). 6. There was no recurrence following total joint replacment or arthrodesis. In conclusion the combined surgery of arthroscopic synovectomy, joint replacement and arthrodesis in the multiple joints was effective in relief of pain and effusion and improvement of functional capcity of the rheumatoid patient if proper medical treatment was given postoperatively.