Résumé
Les pathologies articulaires multiples, comme celles rencontrées dans la polyarthrite rhumatoïde, posent, chez le sujet âgé comme chez le sujet jeune, deux types de problèmes:
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• la stratégie et l’ordonnancement des gestes à réaliser, en essayant de regrouper les gestes opératoires pour raccourcir la période de prise en charge, en respectant les impératifs de rééducation, d’immobilisation et de mise en décharge de chacun de ces gestes et, bien sûr, les limites que pourra mettre l’anesthésiste (durée des interventions combinées, pertes sanguines) en fonction des tares présentées par le patient;
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• le choix du geste à réaliser pour chaque atteinte articulaire: résections, prothèses articulaires ou arthrodèses; l’âge avancé des patients fera privilégier les prothèses chaque fois que possible, pour deux raisons:
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— le souhait de limiter le plus possible les périodes d’immobilisation et de mise en décharge nécessaires aux arthrodèses;
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— la réticence, moindre devant un sujet âgé que devant un sujet jeune, de mettre en place des prothèses articulaires dont la durée de vie est encore insuffisamment connue (épaule inversée, coude, poignet, cheville, doigts).
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Fontaine, C., Wavreille, G. (2013). Lésions articulaires multiples chez le sujet âgé (polyarthrite rhumatoïde). In: Terver, S., Martins-Condé, F., Leblanc, B. (eds) Orthopédie-traumatologie de la personne âgée fragile. Approche pratique en orthopédie - traumatologie. Springer, Paris. https://doi.org/10.1007/978-2-8178-0377-7_32
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DOI: https://doi.org/10.1007/978-2-8178-0377-7_32
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