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 be able to move 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 medicines can't fix it.

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, though, surgery can be less successful. Your doctor can let you know when you’re ready for it.

What Is 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.

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, which will likely be more difficult and may not give you results that are as positive. That’s why the timing of joint replacement surgery is important.

Knee Replacement

If you have a stiff, painful knee that keeps you from doing even simple things and other treatments don’t work anymore, you may want to ask your doctor about knee replacement surgery.

“Minimally invasive” surgery for the knee joint isn’t as drastic and uses a much smaller cut. That means your recovery time should be shorter. Plus, you may move better because you have less scar tissue from the operation.

Hip Replacement Surgery

Hip replacement surgery is usually done when all other treatments have failed to help you. 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. Your doctor will tell you which kind of surgery is best for you.

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Other Surgery

Carpal tunnel release. This can ease the pain of carpal tunnel syndrome in your hand and arm.

Synovectomy. Doctors remove the lining, or synovium, of a joint so it doesn’t damage your cartilage and bone. You may need to get it done more than once if your joint 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, he can remove bits of floating bone or cartilage to improve the way it functions.

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.

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After Surgery

You'll be in the hospital for a few days. You can expect some pain and soreness, but medicines will help control that.

Learn your physical therapy plan and stick with it when you get home. Don't lie around. Practice walking every day.

Within 3 to 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.

Complications

There probably won’t be any complications, but it's important to watch out for them. 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 David Zelman, MD on November 04, 2018

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.

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