When Is Surgery Right for Rheumatoid Arthritis

Drugs for rheumatoid arthritis, or RA, can slow it down. But if you already have joint damage, surgery may be your best option.

The main reasons to choose surgery for rheumatoid arthritis are to get relief from pain and to help you move better. If it succeeds, you may hurt a lot less or even be pain-free. And your range of motion may be much better.

When Is the Timing Right?

It may be time to think about surgery when there is damage to your joint, or the tissues around it, and physical therapy, medications, and other treatments haven’t worked.

You should talk with a rheumatologist, a doctor who treats joint diseases, and an orthopedic surgeon to find out if it would help you, and what results you might get. Surgery can ease pain and allow you to get around much better. But it may not be a perfect fix.

Because any surgery is serious and can have complications, it's best for you to try other treatments first. If you wait too long, surgery may not help as much. Your doctor can let you know when you’re ready for it.

Total Joint Replacement

Your hip and your knee are the joints most often replaced if you have rheumatoid arthritis. Your surgeon takes out the damaged part and puts an artificial joint in its place. The device, called a prosthesis, can be made of plastic, metal, or ceramic.

Depending on things like your weight, health, and activity level, a replaced joint can last more than 20 years. After that, you may need another surgery. The follow-up operation may be more difficult and may not improve your symptoms as much as the first surgery did. That’s why the timing of joint replacement surgery is important.

Knee Replacement

If you have a stiff, painful knee, it can keep you from doing even simple things like walking and climbing stairs. If you’ve tried and haven’t gotten relief from other treatments, you may want to ask your doctor about knee replacement surgery.

Minimally invasive surgery uses a much smaller cut. So you recovery time should be shorter. Plus, you may move better because you have less scar tissue from the operation. Your surgeon will replace only the surface of your knee bones, not the whole joint.­­ The damaged cartilage and small bit of the bone underneath will be taken out. They’re replaced with metal and plastic parts so that you can bend and move your knees as before.

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Hip Replacement Surgery

Your hip is a ball-and-socket joint that’s one of the largest joint in your body. Hip replacement surgery is usually done when all other treatments have failed to help you. Your doctor may recommend it if you have trouble bending, your hip is so stiff that it’s hard to lift your leg, or you’re in constant pain. Whether surgery is right for you will depend more on the severity of your symptoms than your age or weight.

The procedure should relieve a painful hip joint, and make it easier for you to walk.

Hip replacement surgery can be done with a large or small cut. The smaller cut means less blood loss, less pain following surgery, a shorter hospital stay, a smaller scar, and faster healing.

Other Surgery

Carpal tunnel release. This wrist surgery may ease the pain of carpal tunnel syndrome in your hand and arm that sometimes can be caused by RA. This is an outpatient procedure, meaning you go home on the same day.

Synovectomy. Doctors remove the membrane, or synovium, that lines your joint so it doesn’t damage your cartilage and bone. This procedure is most often done on your knees. Your doctor can surgically remove the synovium, or use radiation or chemicals. You may need to get it done more than once if the lining grows back.

Bone or joint fusion surgery. Doctors call this procedure arthrodesis. It’s done to lessen pain in your ankles, wrists, fingers, thumbs, or spine.

Arthroscopy. This is a procedure usually done on large joints. The doctor makes a small cut in your skin and uses a thin lighted tube to look at your joint. If necessary, they can remove damaged or inflamed tissue. This surgery doesn’t slow your RA or keep it from getting worse.

Questions to Ask

Surgery may greatly improve the quality of your life. But any procedure carries risks. Talk to your doctor so you can weigh the pros and cons. You may want to ask:

  • Are there other treatments I might try first?
  • How much better can I expect to feel after the procedure?
  • How much worse could my symptoms get without surgery?
  • What problems can happen during or after the procedure?

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Preparing for Surgery

Your doctor may temporarily stop some of your medications to help you avoid infection. You may need to stop aspirin or other blood-thinning drugs a week or so before your operation. You may also need to stop some supplements, so tell your doctor what you take.

Before knee or hip surgery, your doctor may ask you to practice walking on crutches to strengthen your arm muscles.

You may need to give blood in advance in case you need it during the surgery.

There are many things you can do to lower your risk of complications during surgery and to make your recovery easier.

  • If you have any tooth or gum disease, go to your dentist and get it treated before your surgery. This helps prevent infection from the bacteria in your mouth.
  • If it hurts to pee, tell your doctor. If you have a urinary tract infection, it should be treated before your surgery.
  • Eat a healthy, balanced diet. This will give you the energy and nutrition you need to heal faster.
  • Exercise. People who are fit do better after surgery.
  • If you smoke, quit! Stopping smoking reduces the risk of complications from surgery.
  • Try to lose extra weight if you are going to get joint replacement surgery. Less weight means less stress on the artificial hip or knee, so it will last longer.
  • Prepare your home. You’ll need someone to help you with cooking, cleaning, and shopping while you recover. To make falls less likely, tape down loose carpets or electrical cords.

After Surgery

The procedure can take as little as a couple of hours. Your doctor might put you to sleep. Or they might inject numbing medication so you won’t feel any pain. Some people go home on the same day as their joint replacement surgery. Others may spend a night or longer.

Your recovery may start on Day 1 when you get back on your feet. Learn your physical therapy plan and stick with it when you get home. Practice walking every day. Moving helps prevent blood clots. Keep your wound clean and watch for any sign of infection.

Within 3-6 weeks, you should be getting back to normal activity that’s not too hard. Around this time, you'll see your orthopedic surgeon again to check on how you are healing.

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Complications

Joint replacement surgeries have been around for decades. But any surgery has risks. The most common complications include infections, blood clots, and nerve injury.

Call your surgeon if you notice any of the following:

  • The skin around the area of surgery becomes unusually red or hot
  • The wound drains pus or thick, bad-smelling fluid
  • You develop a fever higher than 101 F
  • You have chest pain or a noticeable shortness of breath
  • You have unusual pain or swelling in one leg
WebMD Medical Reference Reviewed by Brunilda Nazario, MD on September 25, 2020

Sources

SOURCES:

Arthritis Foundation: "Surgery Center."

Bland, J. Journal of Rheumatology, 1974.

Brown, R. Journal of Bone and Joint Surgery (Am), 1993.

Canale, S. Campbell's Operative Orthopaedics, 10th ed., 2002.

eMedicine: "Treatment of Rheumatoid Arthritis."

Harris, E. Kelley's Textbook of Rheumatology, 7th ed., 2005.

Ishikawa, H. Journal of Bone and Joint Surgery, 1986.

Wolfe, F. Arthritis and Rheumatology, 1998.

OrthoInfo: “Total Joint Replacement,” “Total Knee Replacement,” “Total Hip Replacement.”

Johns Hopkins Medicine: “Carpal Tunnel Release.”

UpToDate: “Synovectomy for inflammatory arthritis of the knee.”

Rheumatoid Arthritis Support Network: “RA Surgery: How Successful is Surgery in Treating Rheumatoid Arthritis?”

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