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How does surgery treat rheumatoid arthritis?

Dr. Rachel S. Rohde, MD
Orthopedic Surgeon

Treatments for joints affected by RA are aimed at relieving pain, restoring function and minimizing progression of the disease. With surgery, arthritic joints can be fused (so that they don’t move and therefore don’t hurt) or replaced when nonoperative treatments fail; these options can alleviate pain and restore function.

Surgery for rheumatoid arthritis used to be more common in the days before aggressive DMARD therapy, but it still may be used to relieve pain that no longer responds to medication, to repair or replace a deformed joint, or to improve joint movement and function.

The most common kinds of surgery used in rheumatoid arthritis are synovectomy, tendon reconstruction and joint replacement.

  • Synovectomy is the removal of joint lining that has been damaged by inflammation. It can be done by a standard open incision or by arthroscopy, a minimally invasive procedure in which an arthroscope (a mini camera that enables the surgeon to see inside the joint) is inserted through one tiny incision, and surgical instruments are inserted through another small incision. The advantages over standard surgery are reduced recovery time and reduced trauma to the connective tissue.
  • Tendon reconstruction attaches a new tendon to one that has been damaged by rheumatoid arthritis. Reconstruction may improve function when a tendon has been ruptured.
  • Total joint replacement, also known as joint arthroplasty, involves replacing the ends of each bone in a joint with an artificial joint. Hip and knee replacements are most common, but the procedure can also be done for elbows, shoulders, wrists and fingers.

Complications can occur if the artificial joint does not attach well or the joint becomes infected. However, most artificial hips work well, and many people experience significant pain relief for as long as 20 years after their surgery.

Other less common surgical procedures include arthrodesis, or bone fusion, generally considered a last resort because it involves fusing together bones that form a joint, thereby permanently destroying joint function; osteotomy, which involves cutting and resetting bone in proper alignment to correct a joint deformity; and tenosynovectomy, which removes the covering of the tendon to reduce inflammation.

Watch this video with orthopedic surgeon Umesh Bhagia, MD, from West Hills Hospital & Medical Center to learn about joint replacement surgery.

Surgery may be an option if you have severe joint damage from rheumatoid arthritis (RA). In the right circumstance, it can help reduce pain, improve the affected joint's function and appearance, and enhance your ability to perform daily activities. However, surgery is not right for everyone, and you and your healthcare professional need to discuss the best approach. Factors to consider include your overall health, the condition of the joint or tendon that will be operated on and cost of the surgery.

A common type of surgery prescribed for people with RA is joint replacement, which replaces your damaged joint with an artificial one. One thing to consider is that the artificial joints can wear out, necessitating additional surgery.

Tendon repair, most frequently performed on the hands, is a surgery that repairs overly loose or tight tendons around a joint.

In synovectomy, the inflamed synovial tissue is removed. Synovectomy is performed if the lining around your joint (synovium) is inflamed and causing pain.

RA may also require joint fusion (arthrodesis) or the surgical fusion of a joint to stabilize or realign it for pain relief in cases where joint replacement isn't possible.

Surgery is used to treat rheumatoid arthritis when medications have been deemed ineffective or no longer effective. The doctor must consider any impact surgery may have on other joints and the probability the surgery will ultimately be beneficial. Among possible surgeries to treat rheumatoid arthritis are tendon repair and removal of the lining of the joint. Joint fusion is another possibility and may be performed to stabilize vertebrae in the spine. Total joint replacement, in which an artificial joint is inserted, is relatively commonplace. Such procedures have been particularly successful in the replacement of knees and hips.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.