Surgery

Some people with RA benefit from joint surgery. Surgery can help relieve joint pain, correct deformities, and modestly improve joint function. There are several types of joint surgery techniques. [For more information on surgical procedures, see In-Depth Report #35: Osteoarthritis.]

Synovectomy

Synovectomy is removal of the joint lining (synovium). It is used to remove inflamed tissue that causes pain. Synovectomy can help reduce swelling and slow the progression of joint damage.

Arthroscopy

Arthroscopy is performed to clean out bone and cartilage fragments (a process called debridement) that cause pain and inflammation. It is usually performed on the knee, but it also may be done on other joints:

• The surgeon makes a small incision and injects a sterile solution to make the joint swell for easier viewing.
• A lighted tube, called an arthroscope (which enables the surgeon to view the joint), is then inserted through another small incision.
• Through a third incision, the surgeon trims, shaves, or stitches the damaged tissue. (Arthroscopy is most successful when the removal of cartilage only, and not bone, is involved.)

In many cases, the procedure can be done using local anesthetic, and the patient can go home within a day. In the case of knee operations, patients can resume mild activity in a couple of days, but full recovery can take up to 3 months.

Joint Replacement (Arthroplasty)

Eventually, even after these procedures, rheumatoid arthritis may progress to the point that normal functioning is impossible. In such cases, artificial (prosthetic) replacement joint implants may be considered for shoulders, knees, hips, ankles, wrists and hands, or other joints. Joint replacement (arthroplasty) is usually reserved for people over age 50 or those whose joint damage is rapidly progressing. The joint replacement typically lasts for 20 years or more.

Joint Fusion (Arthrodesis)

If the affected joint cannot be replaced, surgeons can perform a procedure called arthrodesis that eliminates pain by fusing the bones together. However, fusing the bones makes movement of the joint impossible. Bone fusion is most often done in the spine and in the small joints of the hands (wrists, fingers) and feet (ankles, toes).

Review Date: 02/16/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)