Surgery

Where RA is causing severe disability, unless there are contraindications, the

person is likely to be offered joint replacement surgery, or surgery to fuse or stabilise a joint, such as the wrist.

The main indications for surgery are persistent pain despite adequate medication and physical therapy, loss of critical (or functional) joint movement, or joint instability.

Surgery, where appropriate, is most successful in relieving pain and stiffness,

restoring movement in the diseased joint, or in stabilising a joint.

It is now possible to replace the following joints:

• Hip
• Knee
• Ankle
• Shoulder
• Elbow
• Wrist
• Meta-carpophalangeal joints (knuckles)
• Meta-tarsophalangeal (base of toes)

Fowler’s surgery

This is an operation with usually very satisfactory results in which the toe joints are removed leaving the toes to fuse.

Keller’s surgery

This is an operation performed to correct hallux valgus (a deformity where the big toe is bent in towards the other toes). Again, this tends to produce satisfactory results.

Note:

Not all joint replacements are equally successful, the elbow and ankle are most problematic at present