(ii) Hip and knee reconstruction in the rheumatoid patient

SummarySurgical management of the rheumatoid patient requires a multidisciplinary approach. A successful outcome necessitates appropriate management not only of the joint disease but also of the soft tissues, polyarthropathy, co-morbidities, and polypharmacy. At the hip standard implants give good long-term function and implant survivorship, with a complication rate that is similar to other patient groups. At the knee it is important to appreciate the pan-articular nature of the joint involvement and use appropriate implants. Severe ligamentous laxity and fixed deformity may require the use of constrained implants. Complication rates and implant survivorship after hip and knee arthroplasty in patients with rheumatoid arthritis are broadly similar to patients with osteoarthritis. Late functional outcome is dictated, in part, by polyarthritis, rather than the diagnosis of rheumatoid arthritis in itself. Patient satisfaction after hip and knee arthroplasty for rheumatoid arthritis is high.