Rheumatoid Arthritis: When Is Surgery Right?

Medicines for rheumatoid arthritis can slow down the disease, but after joint damage has occurred, surgery may be a reasonable option. Advancements in surgical treatment are giving people with rheumatoid arthritis more chances to maintain function and keep moving.

Having surgery is never something to enter into lightly, but sometimes it can really help. When is the right time for surgery for rheumatoid arthritis, and what can you expect?

There are a couple of reasons to choose surgery for rheumatoid arthritis:

• Relieving pain. Pain relief is the most consistent benefit of orthopedic surgery.
• Improving function. Repair or replacement of a weakened joint may help you regain some of your previous activity level.

When Can Surgery Help RA?

The first question to ask your doctor is, can surgery help? When there is structural damage to a joint or the tissues around it, medicines can't fix it, and surgery may help. Determining whether surgery will fix a joint problem is complicated and requires consulting with your rheumatologist and an orthopedic surgeon.

The timing of surgery is also critical. Because any surgery is serious and can have complications, in general it's delayed until really necessary. If surgery is delayed too long, though, it can be less successful. Figuring the optimal time to perform surgery requires close attention and consideration - again, by both your rheumatologist and orthopedic surgeon.

There are several commonly performed surgeries that can help rheumatoid arthritis:

• Total joint replacement. The hip and the knee are the joints most often replaced in people with rheumatoid arthritis. The damaged structures are taken out, and an artificial joint (prosthesis) put in. The life of a replaced joint is usually 10 to 15 years, depending on factors such as the patient's physical condition, activity level, and body weight. After that point, a second surgery is needed (revision surgery), which is more difficult and the outcome is not generally as good. Therefore, the timing of joint replacement surgery is critical.
• Carpal tunnel release. This can relieve the pain of carpal tunnel syndrome (compression of a nerve in the hand).
• Fusion of cervical vertebrae. In some people with RA, instability of the vertebrae in the neck can occur. Fusion makes the neck more stable and avoids problems, such as nerve damage. It reduces flexibility, but this is usually not a problem.
• Synovectomy. This is the removal of the abnormal joint lining to prevent it from eroding cartilage and bone. While effective, eventually the synovium may grow back and the surgery may need to be repeated.

If you are a candidate for one of these or another surgical procedure to help your rheumatoid arthritis, what can you expect? There are some things to think about and steps you can take to make the surgery and your recovery more successful.