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Principles of lower limb surgery 

Principles of lower limb surgery
Principles of lower limb surgery
Oxford Textbook of Rheumatology (4 ed.)

Peter Wall

, Matthew Wyse

, and Damian Griffin


Lower limb surgery can be broadly grouped into five categories: injections, joint-preserving procedures, soft tissue procedures, arthrodesis, and arthroplasty. Lower limb surgery should be expedited at a time that will offer the optimal outcome and minimal risk. Decisions on diagnosis, surgical timing, and fitness for surgery should be made by a multidisciplinary team which may include both rheumatologists and anaesthetists. A thorough preoperative assessment and adequate preoperative imaging will allow surgery to proceed safely and without undue delay. Measures to reduce the main risks of surgery including infection and venous thromboembolism should be undertaken. The effects on both patients and healthcare resources of surgical site infection are immense. Surgery should take place in modern ultraclean theatres where possible. Controlling and managing surgical blood loss will allow patients to rehabilitate more rapidly; this can be achieved with careful monitoring of blood losses, antifibrinolytics and blood transfusions where necessary. Diagnostic injections should be used to help determine the likely success of surgery in patients with complex symptoms. Therapeutic arthroscopy now offers a real alternative to open surgery for many conditions, and joint-preserving surgery represents a key area where more research is needed in order to help manage rheumatological disease in the future. Ankle arthroplasty continues to improve but early failure is still a concern. Total hip and knee arthroplasty are both highly effective operations in the treatment of arthritis and should not be delayed in patients in whom medical management is failing.

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