There are various treatment options for rheumatoid arthritis (RA), including several types of surgery. RA is an autoimmune disease that causes inflammatory arthritis. In RA, the immune system mistakenly attacks the joints, causing inflammation, joint pain, and joint damage over time. Surgery may help relieve symptoms and improve joint function by removing or replacing damaged tissue.

Understanding the types of surgery for RA can better prepare you to speak with your health care provider about your options. It also can help prepare you for what to expect should you have surgery.

When Is Surgery Appropriate for RA?

Although there is no cure for RA, there are several promising treatment options, including:

• Disease modifying antirheumatic drugs (or DMARDs)
• Biologics
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical and occupational therapy to help preserve range of motion

Conventional therapies like these can often help the majority of people with RA.

However, sometimes an affected joint is damaged to the point where it does not function normally, and is painful despite treatment. In these cases, different types of surgery may help restore joint function and reduce pain.

Surgery is generally considered the last resort for RA treatment after other treatment methods haven’t worked. Although surgery for rheumatoid arthritis can help restore some function to joints and reduce pain, there are also risks involved.

Types of Surgery for Rheumatoid Arthritis

Depending on your goals, your doctor can work with an orthopedic surgeon to determine which surgical options will likely work best for you.

Synovectomy

A synovectomy is a type of surgery that removes the synovium (tissue that surrounds a joint) to relieve synovitis, the inflammation caused by the autoimmune attack on the synovium. A synovectomy is a good option for people who still have cartilage in their joints.

Depending on the situation, a synovectomy can be performed by open surgery or by arthroscopy. Open surgery means that the surgeon cuts open the affected joint to remove the synovium. Arthroscopy, on the other hand, involves the use of a narrow tube with a camera attached to it. A surgeon can use this method to see and repair a joint — while only making a couple of small incisions.

Open surgery makes it easier for the surgeon to remove all of the affected tissue, but arthroscopic synovectomy has a shorter recovery time. Synovectomy results may not be permanent, and symptoms may return years later.

Arthroplasty

Arthroplasty is a joint replacement surgery, often done for the hip, knee, shoulder, and elbow. Joint replacement may be recommended if joint pain and damage prevent you from accomplishing simple daily activities like walking or getting in and out of chairs.

During an arthroplasty, a surgeon replaces the affected joint with a prosthesis (artificial joint) made out of metal, plastic, or ceramic. The artificial joint mimics the movement and mobility of a natural joint. Examples of arthroplasty include a total knee replacement and a total hip replacement. The joints of the fingers can also be replaced to straighten out the fingers.

Results of an arthroplasty tend to last longer than those of a synovectomy, and may reduce the need for medication. Artificial joints can last 15 to 20 years, but the Arthritis Foundation notes that if artificial joints wear out, they might need to be replaced with a joint revision surgery.

Arthrodesis

Arthrodesis is a surgical procedure that fuses the bones of a joint together to form one bone, with a metal implant to support it.

This type of surgery is considered a last resort because it renders the joint unable to move. However, movement might be less important in some joints, like in the heel or big toes. For joints where mobility is more important, like the wrist, a surgeon can perform either a partial or total fusion. A partial fusion allows more mobility, while the total fusion lends greater stability.

Tendon Surgery

In some situations, the tendons or ligaments may not function properly in a joint affected by RA. In these cases, tendon surgery may be recommended. A tendon release surgery disconnects damaged ligaments to reduce pain. A tendon transfer surgery moves healthy tendons from one side of a joint onto the other side to restore movement. Damaged tendons can also be repaired by surgery.

Choosing To Have Surgery

Work closely with your doctor to determine which surgical procedure will work best for you, based on your goals, the affected joint, and the level of damage. Having surgery is often a very personal decision based on your goals. The Arthritis Foundation provides a list of questions to ask yourself about surgery to help decide which options work best for you.

Some myRAteam members have weighed their surgery options and come to different decisions. “I chose not to have surgery on my hands after talking with other patients who had the same surgery,” wrote one member. “Their hands looked better, but they now had all the scars, and after all the hand therapy, they had no more mobility than I have, so I decided it wasn't right for me.”

Another member shared, “I had total knee replacement and everything has gone great. It is the best thing I could have done.”

Recovering From Surgery

Following some surgeries, you may be required to stay in rehab for several days. Before having surgery, be sure to speak with your doctor about recovery time. Your doctor should also follow up with you following surgery to make sure you are healing properly.

Physical therapy will likely be an important factor in helping you recover after surgery. Exercises and stretches can help you to regain strength and movement in the affected joint.

Different types of surgery will have different recovery times, which also can depend on the individual:

• Recovering from a knee replacement may take three to six weeks before you will be able to walk without assistance using a walker or cane. At eight to 12 weeks, you may be able to resume physical activities like hiking and biking.
• A hip replacement may take two to four weeks to heal, depending on your age, nutrition, and general health before surgery. Function and strength generally continue to improve for up to 12 months.
• Wrist replacement requires wearing a cast for several weeks, then a splint for six to eight weeks.
• Wrist fusion requires wearing a cast for six weeks, and full use is allowed after 10 weeks.
• Recovery from a knee synovectomy can take anywhere from five weeks to six months, depending on the severity of the surgery.

Surgery Complications

Common complications of surgery include the risk of infection. One study found that people with RA were at a higher risk for infection following a total hip or knee replacement than people with osteoarthritis, especially if they took biologics. Another study found that the risk of infection was higher for people with RA taking glucocorticoids.

Blood clots are also a risk after surgery. One study found that a partial knee replacement has less risk of blood clots than a total knee replacement, but it has a greater risk of needing surgery again in the future. Your doctor may prescribe medication to prevent blood clots.

Doctors will sometimes tell people to stop taking RA medications leading up to surgery. Some myRAteam members have reported that stopping their medication has caused some RA flare-ups. “The surgery was the easy part, but having to go off my RA medications before surgery caused the worst flare ever,” wrote one member.

Talk To People Who Understand

If you or a loved one have rheumatoid arthritis, you can find support through myRAteam, the social network for people affected by the condition. On myRAteam, more than 148,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you had surgery to help with RA symptoms? Share your experience in the comments below, or share your story on your myRAteam.