2 results
Chapter 126 - Surgical procedures for rheumatoid arthritis
- from Section 24 - Orthopedic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 746-750
-
- Chapter
- Export citation
-
Summary
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder that affects nearly 1% of the adult population, with women being affected earlier and more often than men. The disease typically strikes between the third and sixth decades of life, but children and the elderly can be affected as well.
Despite markedly improved and more aggressive medical management, rheumatoid arthritis continues to be, for many, a progressive disease that ultimately leads to significant joint destruction, severe disability, a lower quality of life, and a shorter life expectancy.
Patients with RA typically present with complaints of overall fatigue, morning stiffness that may improve throughout the day, joint swelling, and pain. Patients have serology positive for rheumatoid factor (Anti-IgG IgM antibodies) and antibodies to cyclic citrullinated peptides (CCP) in addition to plain radiographic findings including subchondral bony erosions, periarticular osteopenia, and soft-tissue edema. Synovial hypertrophy precedes joint destruction and can be diagnosed on ultrasound or MRI. Anti-CCP antibodies can be present and detected months to years before the autoimmune attack on the articular surfaces. These antibodies are positive in 50–60% of individuals with RA; antibodies may be present in otherwise seronegative patients (negative serology for rheumatoid factor). Clinical RA will develop in 95–98% of patients with a positive anti-CCP antibody screen. Early diagnosis is paramount as any delay can often lead to irreversible joint destruction and the resultant morbidity.
Chapter 116 - Arthroscopic knee surgery
- from Section 24 - Orthopedic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 711-714
-
- Chapter
- Export citation
-
Summary
Arthroscopy is the most performed procedure in orthopedics, with the knee being the most common site of surgical treatment. Advances in surgical technique and technology have led to increasing indications for knee arthroscopy. The advantages of arthroscopic surgery include the ability to function in an outpatient surgical setting, limited incisions and resultant improved cosmesis, and lowered risks for perioperative complications such as infection, substantial blood loss, and thromboembolic disease. Image capture systems and the ability to take still photographs and videos intraoperatively provide illustrations of specific pathology and procedures carried out, thereby fortifying the medical record and enhancing postoperative communication with the patient. The benefits carry over to the postoperative period in the form of lower requirements for analgesia and earlier initiation of rehabilitation protocols.
While the utility of knee arthroscopy has primarily been observed in its ability to administer therapeutic maneuvers, the arthroscope remains the gold standard as a powerful diagnostic tool. The process of preoperative counseling with the patient and obtaining informed consent is paramount, as the treatment plan can be modified based on arthroscopic findings. Surgeries performed most regularly include partial meniscectomy, meniscal repair, and anterior cruciate ligament (ACL) reconstruction. The arthroscope is also utilized for complex isolated or multiligamentous reconstructions including posterior cruciate ligament (PCL) and medial collateral ligament (MCL) work, meniscal transplantation, articular cartilage restoration, the irrigation and debridement of a pyoarthrosis, and osseous injuries such as low-energy tibial plateau fractures. A requisite for the arthroscopic management of intra-articular soft-tissue derangements is motion, as preoperative knee motion is the best predictor of postoperative motion. An exception is a locked knee joint secondary to a large bucket-handle meniscal tear.