Most people with RA never have surgery but—like people with osteoarthritis—people with rheumatoid arthritis may elect to have surgery to reduce joint pain and improve everyday function. The most common surgeries are joint replacement, arthrodesis and synovectomy.
Patients may elect to have joint replacements for large joints such as shoulders, hips, or knees as well as smaller joints in the fingers and toes. Joint replacement surgery involves removing either all or part of a damaged joint and inserting a synthetic replacement.
Joint replacements are typically major surgeries with considerable risks, but one study showed that RA patients seemed to do better than osteoarthritis patients during hospital recovery, perhaps because of physician’s hyper-vigilant screening of RA patients.1
In arthrodesis, the damaged joint is removed and the neighboring bones are fused together. The procedure greatly limits movement but increases stability and reduces pain in the affected joints.
Arthrodesis is most commonly used to treat arthritic ankles, toes, wrists, or finger joints. It can also be used to stabilize painful joint(s) in the spine (called spinal fusion). Arthrodesis sometimes requires using bone grafts retrieved from the patient’s own pelvis.
During this procedure, the surgeon removes the inflamed synovial tissue around the joint. By removing the affected tissue, the surgeon hopes to reduce or eliminate the patient’s symptoms. Not all of the tissue can be removed, however, so inflammation, swelling and pain can recur.
A patient must work in conjunction with a surgeon who can give advice and make recommendations regarding which surgery, if any, is appropriate.
Ultimately, each of these surgeries is considered an elective surgery, meaning it is a patient’s choice whether and when to have it.