Recommended sequence for reconstructive surgery in rheumatoid arthritis

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What is the recommended sequence for reconstructive surgery?

  • • Lower-extremity (LE) surgery is done before upper-extremity (UE) surgery because crutch use postoperatively would place excessive demands on any UE reconstructive surgery.
  • • In the multiple involved LE, the hip is reconstructed before the knee to get the best possible alignment of the knee and relieve referred pain from the hip to the knee. However, in patients with normal knee alignment, foot and ankle surgery should be performed before hip and knee replacement to provide stability for LE rehabilitation. Ankle and hindfoot procedures are done before forefoot reconstruction.
  • • In the UE, the preferred order is controversial. Usually proximal joints, nerve, and tendon problems are addressed before the hand and wrist. The wrist is done before the hand joints to help with alignment. For the shoulder and elbow, the most symptomatic joint is usually done first.

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