What to expect from rheumatoid arthritis surgery

Surgery for rheumatoid arthritis is typically used only when all other treatments have not worked. The type of surgery may depend on the affected joint and the severity of the damage.
Healthcare professionals usually only consider surgery for rheumatoid arthritis after trying all other treatments, including pain relief medications, corticosteroids, and immunosuppressants.
Types of surgery for rheumatoid arthritis
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According to a 2018 review of treatment approaches for rheumatoid arthritis, the type of surgery a person has may depend on their individual needs and disease progression.
2018 review
rheumatoid arthritis
Doctors may use the following surgical procedures to help someone with rheumatoid arthritis:
Tenosynovectomy: In this procedure, a surgeon removes the membrane around a tendon to improve function. It is most common for rheumatoid arthritis symptoms affecting the hand.
hand
Osteotomy: In an osteotomy, a surgeon realigns weight-bearing bones to correct abnormalities in the angles of bones. This procedure is most common on the knee.
osteotomy
Joint fusion: Joint fusion procedures can help stabilize joints that are challenging to replace, such as the thumb, wrist, ankle, or cervical spine.
Joint fusion procedures
Small joint implant arthroplasty: In this procedure, a surgeon replaces a joint, typically in the hand, with an artificial implant to improve function and reduce pain.
Metatarsal-head excision arthroplasty: Healthcare professionals may suggest this procedure to relieve rheumatoid arthritis symptoms affecting the forefoot.
Total joint replacement: In a total joint replacement, a surgeon removes the damaged joint entirely and inserts an artificial replacement. This may affect the shoulder, ankle, elbow, knee, wrist, and hip.
total joint replacement
Joint revision: A joint revision procedure removes an old, failed, or infected joint implant and replaces it with a new one.
joint revision
People can speak with a healthcare professional to understand which, if any, surgical procedure might be suitable for managing and treating their symptoms.
How effective is surgery for rheumatoid arthritis?
The success and long-term outcomes of surgery for people with rheumatoid arthritis may depend on the severity of joint damage, the type of surgery they have, and individual factors, such as age and overall health.
A 2019 study examined the outcomes of a total knee replacement and total hip replacement in 142 people with rheumatoid arthritis and 2,070 people with osteoarthritis.
2019 study
total knee replacement
total hip replacement
osteoarthritis
Researchers found that both surgeries led to significant improvements in quality of life and joint-specific questionnaire scores. However, quality of life improvements were lower for people with rheumatoid arthritis.
Researchers suggest that this may be due to the systemic nature of rheumatoid arthritis and the typical involvement of multiple joints.
A 2019 review of 13 studies involving 570 people with rheumatoid arthritis in the foot or ankle suggests that surgical interventions can improve joint function and reduce pain in the short term — from 6 to 12 months.
2019 review
However, the review authors highlight the need for further research, including studies that involve the same surgical instruments and follow-up times.
People can speak with a healthcare professional about the success rates and potential benefits of specific surgery types.
Risks of surgery for rheumatoid arthritis
The risks of rheumatoid arthritis surgery may depend on the type of surgery. For example, people who undergo a joint replacement may have a risk of prosthetic joint infection.
may have
People with diabetes or a compromised immune system may also be more likely to develop joint infections.
The Arthritis Foundation suggests more minor surgeries may have a lower risk of complications than larger or more time consuming surgeries. The organization highlights that total joint replacement may lead to blood clots or cardiac events, including:
Arthritis Foundation
blood clots
heart attack
heart attack
cardiac arrest
cardiac arrest
irregular heart rate
irregular heart rate
Research from 2014 suggests that people with rheumatoid arthritis may have a higher risk of joint dislocation and infection following total joint replacement than people with osteoarthritis. However, further research is necessary.
Research from 2014
Speaking with doctors or surgeons before the procedure can help a person understand the potential risks and complications of their specific surgery.
How to prepare for rheumatoid arthritis surgery
Preparation steps for rheumatoid arthritis surgery may depend on the type of surgery. For example, some surgeries may require people to stay in the hospital for a period, so they may need to pack extra clothing and comfort items.
People may also need to arrange travel to and from the hospital, particularly if they undergo a procedure that temporarily prevents activities such as driving.
A person’s healthcare team will tell them:
will tell them
whether they need to stop eating and drinking for a period before surgery
if they need to start or stop taking any medications
how long they will stay in hospital
what they should bring to the hospital
if they need to attend any pre-surgery assessments
Recovering from rheumatoid arthritis surgery
Recovery timelines may depend on the type of surgery a person has and individual factors, such as age and overall health.
Regardless of the type of surgery, the recovery period may involve rehabilitation and exercise to build strength and mobility in the affected joint.
may involve
If a physical therapist helps someone practice muscle-strengthening exercises before surgery, such as a knee replacement, they may experience a shorter recovery period after surgery.
People can speak with their healthcare team about their specific recovery process. A doctor can provide more information about an individual’s expected recovery timelines and any restrictions on activities during this period.
When is the time right for rheumatoid arthritis surgery?
Healthcare professionals will not typically consider surgery for someone with rheumatoid arthritis before trying other treatment options.
Before considering surgery, healthcare professionals will suggest taking medications, including nonsteroidal anti-inflammatory drugs, corticosteroids, and disease-modifying antirheumatic drugs.
corticosteroids
disease-modifying antirheumatic drugs
People may want to consider surgery if they have tried all other treatment options and the following conditions apply:
the following
joint pain affects their mood, relationships, and daily lives
joint pain interrupts their sleep
they are experiencing significant side effects from medications
pain and stiffness have significantly worsened
imaging tests show severe joint damage
they have given up enjoyable activities because of their symptoms
People can also speak with a doctor to understand how much surgery may be able to improve their symptoms. In some cases, the risks of surgery may outweigh its potential benefits.
Frequently asked questions
The cost of surgery for rheumatoid arthritis depends on the type of surgery and insurance coverage. Extensive surgeries requiring a hospital stay will typically cost more than more minor surgeries.
insurance coverage
People can speak with their healthcare team and insurance provider for an accurate estimation of surgery costs.
Surgery cannot cure rheumatoid arthritis, but it may help restore function and relieve symptoms such as pain.
may help
However, in some cases, such as during a total joint replacement, surgery may not fully restore a person’s joint function.
The type of surgery a doctor suggests for rheumatoid arthritis may depend on the area the condition affects and the severity of joint damage.
For example, a doctor may suggest a joint fusion procedure for joints that are challenging to replace, such as those in the wrist or thumb. If rheumatoid arthritis causes angulation abnormalities in weight-bearing joints, a doctor may suggest osteotomy.
If rheumatoid arthritis causes severe damage, a doctor may suggest a total joint replacement in the affected area.
Summary
Surgical procedures for rheumatoid arthritis typically aim to reduce pain and restore function. However, doctors only consider surgery for rheumatoid arthritis after trying all other treatment approaches first.
Surgery can realign bones to correct structural abnormalities, fuse small joints together for stability, and completely replace joints with artificial implants when damage is extensive.
People can speak with a healthcare professional about surgery to understand the potential benefits and risks and which procedure type may be suitable for them.