[Modern rheumatism surgery: prospects, hazards, results].
The conservative management of rheumatoid arthritis (RA) the value of which is a symptomatic or at best a pathogenetic one, has failed to achieve a decisive breakthrough in the past 25 years. By contrast the orthopedic-surgical management of RA has proved able to rehabilitate patients who would otherwise gradually lose their independence. The close cooperation between rheumatologists and orthopedists in specific rheumatoid arthritis centers and the recruitment of specially trained therapeutic teams have boosted the recent progress in this field. However, the main responsibility for the patient continues to lie with the rheumatologist. Operative procedures are only considered when despite a well-conducted conservative treatment signs of progressive articular destruction appear; they do not interrupt the conservative management, but are a completion of it. The art of the rheumatology-surgeon reveals itself in his ability to set up a clear-cut therapeutic plan with priorities. In particularly complex cases the indication will require a team discussion, which includes the occupational therapist who has previously assessed the patient's handicap in the performance of ADL and will be centered around the patient, whose motivation is of crucial importance to the success of our efforts. Throughout the many years of active practice and by performing thousands of operations--preventive (e. g. synovectomies) as well as reconstructive ones (e. g. arthroplasties)--we have gained a vast experience in different operative procedures, which we have come to divide into three categories. Whenever possible we start with an operation regarded as particularly promising, thus overcoming the patient's understandably reserved attitude towards surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Gschwend
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N
Klinik Wilhelm Schulthess, Zurich.
D001172:Arthritis, Rheumatoid / Q000534:rehabilitation / Q000601:surgery*; D001178:Arthroplasty; D006801:Humans; D007595:Joint Prosthesis; D009788:Occupational Therapy; D009985:Orthopedics; D010347:Patient Care Planning; D010348:Patient Care Team; D012219:Rheumatology; D000074402:Synovectomy
Moderne Rheumachirurgie: Chancen, Gefahren, Ergebnisse.