Surgery
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.
If you have serious joint damage, talk to your rheumatologist and an orthopedic surgeon about the risks and benefits of surgery.
