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WOUND HEALING AFTER OPERATIONS ON PATIENTS WITH RHEUMATOID ARTHRITIS

Richard W. Garner 1; Alastair G. Mowat 2; ; and Brian L. Hazleman 2

1 Rheumatology Unit, Nuffield Departments of Medicine and Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre; Louisville, Kentucky, United States Of America
2 Rheumatology Unit, Nuffield Departments of Medicine and Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre; Oxford, England

1. The incidence of failure of wound healing by primary intention due to infection, haematoma and gaping of wound edges, has been compared in 100 patients with rheumatoid arthritis and in 100 matched controls following a variety of orthopaedic operations.

2. There were thirty-one cases of failure of wound healing in the patients with rheumatoid arthritis and sixteen in the controls (P<·02). There was no significant difference in the numbers of infected wounds or in those in which a haematoma developed. However, there was a significant excess of wound edge separation in the rheumatoid patients (thirteen) compared with the controls (four) (P<·05).

3. The problems of wound healing were minor since there was no difference in the mean number of days ±1 standard deviation to wound healing between the patients: l6·6±7·5 days; and the controls: 15·2±7·9 days.

4. There was no correlation between duration or severity of rheumatoid disease and wound healing.

5. There was no difference in wound healing between patients with sero-positive and seronegative disease.

6. Forty-nine patients received corticosteroid therapy in small dosage. This was associated with an increased incidence of wound infection. Treatment for more than three years was associated with a significant increase in the mean number of days to wound healing.

7. The results are discussed in the light of the increased incidence of infection in several sites in patients with rheumatoid arthritis and of the effect of corticosteroid therapy on wound healing in man and experimental animals. It is suggested that more marked abnormalities might have been expected, and that these findings may need to be considered in the future surgical management of such patients.
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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General