The timing of surgery in rheumatoid arthritis

A very accurate preoperative assessment of both the functional and social implications of the patient's problems should be performed. This forms the basis upon which an opinion as to which surgical procedures would be of benefit in any given patient situation can be made. At the same time we have to take cognisance of the importance of various structures in the surgical hierarchy. These have been outlined: nerves, flexor tendons, wrists, thumbs, metacarpophalangeal joints, extensor tendons, proximal interphalangeal joints, and distal interphalangeal joints. It is important to bear in mind that each surgical procedure takes a finite recovery time and takes a little more out of the patients, particularly if they have had rheumatoid arthritis for many years and are perhaps less able to withstand repeated major surgical procedures. These patients have often had hip surgery, knee surgery, shoulder surgery, elbow surgery before they come to their hand and foot surgery. I think it is very important to ensure that patients are not overwhelmed by this mammoth list of surgical procedures that have been identified as being helpful. Composite surgery is beneficial to the patient who is developing “surgical fatigue” where thumb fusion, wrist fusion or replacement and metacarpophalangeal joint surgery may be combined if appropriate.