Surgical Repair and Reconstruction in Rheumatoid Disease

Over a decade has passed since the publication of the First Edition; we have yet to understand the pathogenesis of rheumatoid arthritis and there is still no cure. A wide range of developments in techniques, materials, imaging and understanding of biological processes justify this rewrite. Above all, the experience of many colleagues worldwide with commitments to a particular anatomical or technical area has led to a more balanced and refined approach to the problems of rheumatoid surgery. It has also highlighted areas where we need radically new solutions. The two additional authors, apart from their relative youth, bring expertise in their respective fields: Steve Copeland, on the shoulder and Jo Edwards on the mechanisms of tissue damage and the rationale of medical measures. We are conscious of the importance of communication between orthopaedic colleagues worldwide and the need to use a language shared with rheumatologists and histopathologists. We consider it is for the surgeon to know more of this disease than the narrow confines of surgical technique. We are doctors with a special interest in rheumatoid arthritis and we aim to maintain the broader view rather than be confined by the limitations of over specialisation. Although joint replacement is at present a major weapon for the relief of suffering we appreciate that it is an unphysiological procedure and there are other directions for progress.