Surgery for Rheumatoid Arthritis

As with any treatment regimen, the goals of surgery for rheumatoid arthritis symptoms are to reduce pain, protect the affected joints, and improve the patient’s ability to function in everyday life. Although there are many surgical options for treating rheumatoid arthritis, it is important to remember that surgery is not appropriate for everyone.

Surgery for osteoarthritis (“aging” arthritis) is more common than for rheumatoid arthritis, because osteoarthritis will typically affect only one or a few joints, whereas rheumatoid arthritis will often affect multiple joints, especially the small joints in the hands and wrists.

Surgery for rheumatoid arthritis may be appropriate if both doctor and patient agree that surgery is the right course of action after repeated physical evaluation and careful consideration of the risks, benefits, and costs.

The type of surgery depends mainly on which joint is affected:

• Joint Replacement for hips or knees. Joint replacement surgery involves removing either all or part of a damaged joint and inserting a synthetic replacement. Although it is available for a number of different joints, joint replacement is most commonly used in hips and knees. New technologies have decreased the level of invasiveness and recovery time for joint replacement surgeries.
• Arthrodesis for ankle, toe, wrist, or finger joints. In arthrodesis, the damaged joint is removed and the neighboring bones are fused into one immobile unit, often using bone grafts retrieved from the patient’s own pelvis. The procedure greatly limits movement, but can be effective for increasing stability and reducing pain in the affected joints. This procedure is most commonly used in ankles, wrists, fingers, and toes. Spinal fusion can be used to stabilize a painful joint (or joints) in the spine.
• Synovectomy. In this procedure, the surgeon removes the inflamed synovial tissue around the joint. This procedure is not frequently used because not all the tissue can be removed, and it can therefore recur causing more swelling and pain.