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Arthritis und Rheuma 2012; 32(05): 275-283
DOI: 10.1055/s-0037-1618134
Operationsverfahren in der Rheumaorthopädie
Schattauer GmbH

Dringlichkeit von operativen Eingriffen in der Rheumatologie

Urgency of surgical interventions in rheumatology
M. Fuerst
2   UKSH Campus Kiel, Sektion rheumatologische und onkologische Orthopädie
,
E. Schenzer-Hoffmann
2   UKSH Campus Kiel, Sektion rheumatologische und onkologische Orthopädie
,
L. Gerdesmeyer
2   UKSH Campus Kiel, Sektion rheumatologische und onkologische Orthopädie
› Author Affiliations
Further Information

Publication History

Publication Date:
20 December 2017 (online)

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Zusammenfassung

Die Planung von Operationen bei Patienten mit entzündlich rheumatischen Erkrankungen stellt eine große Herausforderung dar. Neben den unterschiedlichen zugrundeliegenden rheumatischen Erkrankungen, deren Aktivität und Befallsmuster und nicht zuletzt deren begleitende medikamentöse Therapie, muss großen Wert auf die richtige Terminierung der Operation gelegt werden. Bei Weitem nicht alle rheumaorthopädischen Eingriffe sind als elektive Eingriffe einzustufen. Die Schwierigkeit der richtigen Terminierung besteht auch darin, dass aus einem bestehendem Funktionsdefizit oder einer Schmerz situation nur sehr eingeschränkt auf die Dringlichkeit der anstehenden Operation zu schließen ist: Eine zervikale Myelopathie muss nicht zwingend mit einer fulminanten klinischen Symptomatik einhergehen, die grobe Endoprothesenlockerung an Hüft- und Kniegelenk ist nicht selten schmerzarm, aber mit fatalen Folgen bei zu später operativer Intervention. Dieser Beitrag soll einen Überblick über die Krankheitsbilder beim Rheumapatienten geben, die eine rasche operative Intervention erfordern.

Summary

The planning of surgery in patients with inflammatory rheumatic diseases presents a major challenge. In addition to the different underlying rheumatic diseases, their activity and infection pattern and not least their adjuvant drug therapy, great importance must be attached to the correct timing of the operation. By no means can all rheumatic orthopaedic operations be classed as elective surgery. The problem with correct timing is that conclusions as to the urgency of the imminent operation can only be drawn to a limited extent from an existing functional deficit or pain situation. Cervical myelopathy need not necessarily be associated with fulminant clinical symptoms, a gross endoprosthetic loosening at the hip and knee joint is not infrequently almost painless, but the consequences are disastrous if surgical intervention is too late. This article is intended to provide an overview of the clinical symptoms in rheumatic patients who require urgent surgical intervention.

Schlüsselwörter

Rheumatoide Arthritis - Rheumaorthopädie - septische Arthritis - Operation

Keywords

Rheumatoid arthritis - rheumatic orthopaedics - septic arthritis - operation
 

  • Literatur

  • 1 Tillmann K. Indications for emergency operations in rheumatoid arthritis. Z Rheumatol 1985; 44 (01) 26-29.
    Google Scholar
  • 2 Gravius S. Perioperatives Management. In: Ruchholtz S, Wirtz DC. Hrsg. Orthopädie und Unfallchirurgie (essentials). Stuttgart, New York: Thieme; 2010: 24-31.
    Google Scholar
  • 3 Dubost JJ. et al. Polyarticular septic arthritis. Medicine (Baltimore) 1993; 72 (05) 296-310.
    CrossrefGoogle Scholar
  • 4 Galloway JB. et al. BSR Biologics Register. Risk of septic arthritis in patients with rheumatoid arthritis and the effect of anti-TNF therapy: results from the British Society for Rheumatology Biologics Register. Ann Rheum Dis 2011; 70 (10) 1810-1814.
    CrossrefGoogle Scholar
  • 5 Schmidt HKG. et al. Empyem behandlung. Trauma und Berufskrankh 2001; 7 (Suppl. 01) 120-129.
    Google Scholar
  • 6 Blackburn Jr WD. et al. GS. Infection versus disease activity in rheumatoid arthritis: eight years’ experience. South Med J 1986; 79: 1238-1241.
    CrossrefGoogle Scholar
  • 7 Kherani RB, Shojania K. Septic arthritis in patients with pre-existing inflammatory arthritis. CMAJ 2007; 176 (11) 1605-1608 Erratum in: CMAJ 2007; 177 (5): 489.
    CrossrefGoogle Scholar
  • 8 Fink B. et al. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 2008; 90 (07) 874-878.
    PubMedGoogle Scholar
  • 9 García-De La Torre I. Advances in the management of septic arthritis. Rheum Dis Clin North Am 2003; 29 (01) 61-75.
    CrossrefGoogle Scholar
  • 10 Sato H. et al. Procalcitonin Is a Specific Marker for Detecting Bacterial Infection in Patients with Rheumatoid Arthritis. J Rheumatol. 2012 Jul 1.
    Google Scholar
  • 11 Jerosch J, Prymka M. [Arthroscopic therapy of septic arthritis. Surgical technique and results]. Unfallchirurg 1998; 101 (06) 454-460.
    CrossrefGoogle Scholar
  • 12 Diefenbeck M. et al. Gelenkinfektion. Bekanntes und neue Trends. Unfallchirurg 2012; 115: 489-495.
    CrossrefGoogle Scholar
  • 13 Hansen AD. Managing the infected knee: as good as it gets. J Arthroplasty 2002; 17 (Suppl. 01) 98-101.
    CrossrefGoogle Scholar
  • 14 Tsukayama DT. et al. Infection after total hip arthroplasty: a study of treatment of one hundred and six infections. J Bone Joint Surg Am 1996; 78: 512-523.
    CrossrefGoogle Scholar
  • 15 Greidanus NV. et al. Use of erythrocyte sedimentation rate and c-reactive protein level to diagnose infection before revision total knee arthroplasty: a prospective evaluation. J Bone Joint Surg Am 2007; 89-A: 1409-1416.
    Google Scholar
  • 16 Saleh KJ. et al. Modes of failure and preoperative evaluation. J Bone Joint Surg Am 2003; 85 A (Suppl. 01) 21-25.
    Google Scholar
  • 17 Fink B. et al. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 2008; 90 (07) 874-878.
    PubMedGoogle Scholar
  • 18 Zimmerli W. et al. Prosthetic joint infections. New Engl J Med 2004; 351: 1645-1654.
    CrossrefGoogle Scholar
  • 19 Della Rocca GJ. et al. Periprosthetic fractures: epidemiology and future projections. J Orthop Trauma 2011; 25 (Suppl. 02) 66-70.
    CrossrefGoogle Scholar
  • 20 Gaski GE, Scully SP. In brief: classifications in brief: Vancouver classification of postoperativeperiprosthetic femur fractures. Clin Orthop Relat Res 2011; 469 (05) 1507-1510.
    CrossrefGoogle Scholar
  • 21 Stange R. et al. Periprosthetic fractures. An interdisciplinary challenge. Unfallchirurg 2011; 114 (08) 688-696.
    CrossrefGoogle Scholar
  • 22 Rayan F, Haddad F. Periprosthetic femoral fractures in total hip arthroplasty – a review. Hip Int 2010; 20 (04) 418-426.
    CrossrefGoogle Scholar
  • 23 Anglen J. et al. Locking plates for extremity fractures. J Am Acad Orthop Surg 2009; 17 (07) 465-472.
    CrossrefGoogle Scholar
  • 24 Crockard HA. Surgical management of cervical rheumatoid problems. Spine 1995; 20: 2584-2590.
    CrossrefGoogle Scholar
  • 25 Rawlins BA. et al. Rheumatoid arthritis of the cervical spine. Rheum Dis Clin North Am 1998; 24: 55-65.
    CrossrefGoogle Scholar
  • 26 Winfield J. et al. A prospective study of the radiological changes in hands, feet and cervical spine in adult rheumatoid disease. Ann Rheum Dis 1983; 42: 613-618.
    CrossrefGoogle Scholar
  • 27 Boden SD. et al. Rheumatoid arthritis of the cervical spine: A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am 1993; 75: 1282-1287.
    CrossrefPubMedGoogle Scholar
  • 28 Weinstein PR. et al. Spinal cord injury, spinal fractures and spinal stenosis in ankylosing spondylitis. J Neurosurg 1982; 57: 609-616.
    CrossrefGoogle Scholar
  • 29 Simmons EH, Bernstein AJ. Fractures of the spine in ankylosing spondylitis. In: Floman Y, Farey JPC, Arcensond C. eds. Thoracolumbar spine fractures. New York: Raven; 1993: 385-408.
    Google Scholar
  • 30 Einsiedel T. et al. Special problems and management in lesions of cervical spine affected by Bechterew’s disease. Unfallchirurg 2001; 104: 1129-1133.
    CrossrefPubMedGoogle Scholar
  • 31 Shapiro JS. The wrist in rheumatoid arthritis. Hand Clin 1996; 12: 447-498.
    Google Scholar
  • 32 Papp SR. et al. The rheumatoid wrist. J Am Acad Orthop Surg 2006; 14 (02) 65-77.
    CrossrefGoogle Scholar
  • 33 Petersson CJ. Painful shoulders in patients with rheumatoid arthritis. Prevalence, clinical and radiological features. Scand J Rheumatol 1986; 15: 275-279.
    CrossrefGoogle Scholar
  • 34 Björnsson HC. et al. The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears: structural and clinical outcomes after repair of 42 shoulders. Acta Orthop 2011; 82 (02) 187-192.
    CrossrefGoogle Scholar
  • 35 Smith AM. et al. Rotator cuff repair in patients with rheumatoid arthritis. J Bone Joint Surg Am 2005; 87 (08) 1782-1787.
    Google Scholar