Treatment Of Rheumatism - Operation

Please do not pin your hopes on operations. A few operations are done to help those with rheumatism but each has only a small range of conditions in which it is useful and a large range of conditions in which it would be no use or harmful. Operations on bones also need considerable perseverance on the part of the patient. Moreover, operation for rheumatism are not a matter of life and death but a matter of comfort and discomfort. A surgeon therefore has to weigh up many factors, including the age, size, work and temperament of the patient, as well as what is wrong with the joints, before recommending an operation.

Four main types of operations are done -- replacement, fixation, correction of deformity and operations on parts other than bone.

1. Replacement operation:

This applies particularly to the hip. If the bones forming the hip joint are worn and painful they can sometimes be replaced by metal or plastic parts. One of the difficulties in the early days of this sort of operation was that the inside of the hip is very corrosive to metal and is subject to such tremendous mechanical strains that the metal or plastic parts broke rather easily. The mechanical difficulties have now largely been overcome. The operation remains a big step, however, and therefore one that will not be recommended unless the surgeon is sure that it has a lot to offer.

2. Fixation operation:

This is also known as arthrodesis. Where two bones keep rubbing and causing pain it may be possible to fix them together by a metal or bone pin to stop them moving. A variant of this is applied to the hip by an operation known as osteotomy which lessens the movement of the hip joint. If you have this done you exchange a painful joint for a stiff one and you have a joint which, besides being a nuisance, throws unusual strains on nearby joints; the surgeon has to be satisfied that these other joints can stand these strains and that you will be able to manage the inconvenience of the stiff joint.

3. Correction of deformity

The best known example of this is the operation done for bunions or, to be more accurate, for the crooked toe that has caused the bunion, for a bunion is really the inflamed skin and ligaments over the bone where it sticks out: in this operation a wedge-shaped piece is cut out of the bone so that the toe can once more point the right way; at the same time any surplus bone that would inflame the skin is cut off. Operations for the corrections of the deformities sometimes caused by bad rheumatoid arthritis are being developed but the great risk is that of stirring up the arthritis.

4. Operations on the structures

Operations on the structures round the joints are in their infancy and many problems have to be solved before they can be recommended as freely as the operations for deformed toes. All through this matter of operations in rheumatism is the knowledge that 'you can't make a silk purse out of a sow's ear"; you may be much better off with a food 'sow's ear' than a poor 'silk purse'.

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