Polyarthrite rhumatoïde avancée de la main: intervention chirurgicale et insertion d’une prothèse

23 juillet, 2017

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The patient, a middle-aged woman, presents a picture of advanced rheumatoid arthritis in both hands. The degree of dislocation of the upper extremities and the state of nodulosis – the appearance of rheumatoid nodules – allow us to evaluate the high level of impact of the situation.

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The upper radiograph shows clearly the manifestations of rheumatoid arthritis in both hands of the patient: dislocations and joint damage, deviations, bone erosion, etc.

The problem

Unlike osteoarthritis, which originates in processes of joint degeneration (natural erosion or ‘abnormal’ use), rheumatoid arthritis is an autoimmune pathology, ie it’s the patient’s own body which ‘attacks’ the joints treating them as ‘foreign bodies’.

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Both compositions (upper and lower) show the progression of nodulosis and the functional difficulties of the patient in both upper extremities, among other aspects.

Thus the patient suffers an inflammatory reaction in the affected areas, specifically in the synovial tissue that surrounds the joints, which releases substances toxic for the articular cartilage. Broadly speaking, the body itself is devastating the cartilaginous tissue and, in the process, destroying the arthritic joint. Polyarthrite rhumatoïde

The objectives

Dr. Piñal and his surgical unit design an approach with three fundamental goals: to obtain a maximal recovery of function, minimize the aesthetic impact and, in turn, eliminate other conditions associated with the pathology, such as those existing in the wrist, for example.

The plan

The surgical approach of the case involves the removal of the bone part of the damaged joint. Subsequently a silicone prosthesis with a high degree of polymerization (ie, strength and durability) is inserted as a replacement element. This prosthesis is incorporated into the patient’s own ligament and tendon system, which acts on the ‘new’ joint and facilitates their movements by bending, stretching, etc.

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The procedure, of 3 to 4 hours depending on the rest of manifestations of the arthritis to be addresed, involves the removal of the damaged joint and its replacement by a prosthesis of high polymerization.

The results

After 3-4 hours of intervention and 6 weeks of postoperative immobilization, the results four months after the procedure are evident, especially observing the contrast between the operated hand and the one still pending. As the images show, these results are seen both in mobility-function and in the aesthetic recovery of the limb, achieved, among other actions, through the surgical removal of the rheumatoid nodules.