Surgical management for rheumatoid arthritis / 全日本鍼灸学会雑誌

ABSTRACT

Osteoarthritis (OA) and rheumatoid arthritis (RA) are the most frequently seen among the disorders belonging to rheumatism. But the surgical treatment of RA is different from that of OA. Although both diseases affect the various joints, the surgical intervention for the knee is mainly described as they cause to the severe disturbance of the gait.<br>Osteoarthritic knee has the varus deformity and the joint destruction of medial compartment. But the osteoarthritic knee with varus deformity has almost normal cartilage and joint space in the lateral side of the knee. The malalignment of the knee is corrected using valgus osteotomy and the weight bearing on the medial side is transfered to the lateral side. That is, high tibial osteotomy, a method of the correction of varus deformity, is necessary to be performed.<br>On the other hand, rheumatoid arthritis is the disease of which joints are gradually destructed by the chronic inflammation of the membrane of the joints. Therefore, the resection of the inflammed joint membrane, that is, the synovectomy, is done to prevent the destruction of the joints. The knees which have already destructed by rheumatoid inflammation cannot be fruitfully managed with only synovectomy. Not only medial but also lateral compartment of the knee are equally damaged in the majority of the rheumatoid knees, so that the destructed knee of RA has lately been treated using the total knee arthroplasty. The rheumatoid case, which cannot walk and is obliged to use a wheel chair, is able to walk again after the total knee arthroplasty.<br>Sometimes rheumatoid patients are managed in the many joints besides the knee by using the joint arthroplasty which is suitable to each joint. The acupuncture and moxibustion should be carefully carried out to the joint with the total arthroplasty.