What Types of Surgery Are Used in Rheumatoid Arthritis?

Patient Expert

Although I have rheumatoid arthritis and I know what can possibly happen to my body now or in the future, I'd still like to hide my head in the sand as much as anybody.   However, I can't do that.   I have a responsibility to research topics and provide information for the community's benefit as well as my own.

You may recall that even before I saw a rheumatologist and received the official diagnosis of RA, I was consulting a hand surgeon about getting steroid injections in my wrists and possibly facing carpal tunnel release surgery in the future.   I was terrified and still shake inside when I think of anybody cutting open such a delicate area as a wrist, especially MY wrists.

My story didn't end up with surgery, for which I am thankful, but it did end up with facing a life with RA.   With the powerful drugs which are more commonly used nowadays with patients earlier in their disease course, fewer and fewer surgeries are necessary.   A study released last year noted that the rate of surgeries in RA patients has declined dramatically in the past 25 years.   That's encouraging news

However, there comes a point where you might need to know the possible types of surgeries which are commonly used to assist patients with rheumatoid arthritis.   This post is intended to be an introduction to the various types of surgery used to alleviated pain or improve function of damaged joints and tissue.   Later posts will go into greater detail regarding select types of joint surgery.

  • Total joint replacement (total arthroplasty) involves the surgical reconstruction of a joint, often knees or hips.   Damaged parts of the joint are removed, ends of bones may be resurfaced or relined, and a prosthesis made of metal and plastic is inserted.   With current materials, a new joint will last between 20 and 30 years.   Total joint replacement is more common in knees and hips.

  • Joint resection (arthroplasty) involves removing a portion of the bone from a stiffened joint, improving range of motion by increasing the space between the bone and the socket.   The joint becomes less stable, but pain is relieved and motion is restored.   Scar tissue eventually fills the gap, narrowing the joint space again.   Joint resection is more common in elbows, shoulders, ankles, and finger joints.

  • Osteotomy is listed by the Arthritis Foundation as a surgical option, however not commonly used in RA.   It involves cutting bone to redistribute weight within a joint to a section with healthier tissue.   It is not done on joints showing inflammation which explains why it is not a popular choice in rheumatoid arthritis.

  • Joint fusion (arthrodesis) involves the fusing together of two bones in a joint.   It may be recommended to stabilize or realign a joint when joint replacement isn't an option.   With joint fusion the joint does become immobile.   Joint fusion is more common in the ankles, wrists, fingers, toes and spine.

  • Arthroscopic surgery involves the insertion of a small fiber-optic instrument (arthroscope) through a small incision which enables a close look at the inside of a joint.   While in the joint, he surgeon can take tissue samples, remove loose cartilage, repair tears, smooth a rough surface, or removed diseased synovial tissue.   Arthroscopic surgery is more commonly used on knees, but can also be used on ankles, shoulders, wrists, elbows, and hips.

  • Synovectomy is the removal of the joint lining, called the synovium, which may become severely inflamed and cause pain in RA patients.   The desired result is less swelling and pain in the joint with the prevention of further joint damage.   Because this procedure is more successful in patients with less bone erosion, synovectomy is recommended in early stages of the disease.

  • Tendon repair can be done arthroscopically or through open incisions depending upon the location and extent of damage.   Tendons around your joint may become loose or rupture from inflammation and joint damage caused by the disease.

  • Carpal tunnel syndrome is common in patients with RA.   Inflammation in the wrist puts pressure on the medial nerve causing pain and hand dysfunction.   When conservative treatments have not been effective, surgery may become necessary.   In carpal tunnel release, the surgeon cuts the transverse carpal ligament which immediately relieves the pressure on the medial nerve.

So these are the types of surgeries which are more common in rheumatoid arthritis cases.   In follow-up posts, I will go into greater detail on just a few of these.   If you have had any type of joint surgery due to RA, please tell us your story.   I'd love to learn from you as would our community.

SOURCES: Encyclopedia of Surgery: A Guide for Patients and Caregivers  (excellent explanations of many terms and procedures)

Arthritis Foundation: Rheumatoid Arthritis Treatment Options

Mayo Clinic: Rheumatoid Arthritis Treatment and Drugs

Synovectomy on Orthopale.com