Here's a guide to the most common joint surgeries

If medical therapy fails to control your rheumatoid arthritis (RA) in one or more joints, surgery could be an option to help improve your condition. The main reasons for considering surgery are problematic joint pain (with activity or at rest) and an unacceptable decline in your ability to function. Before surgery is considered, non-surgery options including the use of disease modifying agents (DMARDs) and biological therapies would usually have been tried.

The following is a brief guide to some of the surgical options used in RA. It may help you have an informed discussion with your doctor about whether these are suitable for you.

Arthroscopy

What is it? 

Surgeons use this technique -- which involves small cuts in the skin, specialised instruments and a tiny camera -- to fix tears in soft tissues around the knee, hip, shoulder and other joints; repair damaged cartilage; and remove broken, free-floating cartilage pieces.

This procedure has become much less common with the development of more effective medical treatments.

Best candidates: 

Active people younger than 40 years.

Pros: 

Often immediately reduces pain and improves range of motion and other symptoms. May delay or eliminate the need for an artificial joint.

Cons:

It is not  known whether arthroscopy will stop the further deterioration of the joint

Osteotomy

What is it? 

The procedure involves cutting and removing bone or adding a wedge of bone near a damaged joint. The purpose of this surgery to correct deformities in a joint such as the knee. In the knee, for example, an osteotomy shifts weight from an area damaged by arthritis to an undamaged area. In the hip it is often used to correct misalignment (hip dysplasia) that occurs early in life.

Best candidates: 

Patients in their 30s and younger or who are too young for total joint replacement.

Pros: 

Can halt damage and delay the need for a joint replacement.

Cons: 

Osteotomies are not a simple procedure and generally performed by only a small number of surgeons.

Synovectomy

What is it? 

In people with RA, the lining of the joints – the synovium – can become inflamed or grow too much, damaging surrounding cartilage and joints.In this procedure surgeons remove most or all of the affected synovium, either in a traditional, open surgery or by using arthroscopy.

Best candidates: 

People with limited cartilage damage in the affected area who have tried anti-inflammatory medications, but who continue to have inflammation or overgrowth of the synovium around the knee, elbow, wrist, fingers or hips.

Pros: 

Relieves pain and improves function, and people who have had the procedure may be able to reduce their dosage of anti-inflammatory drugs.  

Cons: 

The procedure may limit range of motion and provide only temporary relief of symptoms.

Arthrodesis (joint fusion)

What is it? 

In this procedure surgeons use pins, plates, rods or other hardware to join two or more bones in the ankles, wrists, thumbs, fingers or spine, making one continuous joint. Over time the bones grow together and lock the joint in place. One of the aims of this surgery is to stabilise damaged joints that cannot be easily replaced. 

Best candidates: 

People with severe joint damage from RA.

Pros: 

This procedure is very durable, and results should last a lifetime. People who have weight-bearing joints fused can often take part safely in high-impact physical activity. 

Cons: 

Fusing joints eliminates their motion and reduces flexibility. It also changes the joint’s normal biomechanics, which can put stress on surrounding joints and lead to the development of arthritis in other areas. 

Total Joint Replacement (TJR), or Total Joint Arthroplasty 

What is it? 

The damaged joint is replaced with an implant that mimics the motion the natural joint and is made from combinations of metal, plastic and/or ceramic components.

Best candidates: 

People with severe joint pain who haven’t been helped by other treatments. Improvement in implant durability means that TJR is more common in younger people than in the past.

Pros: 

Strong, proven track record for safety and success; reduces pain and improves mobility, daily functioning and quality of life.

Cons: 

All artificial joints can wear out, which may require joint revision surgery. Implants made entirely of metal (called metal-on-metal) can release metal ions that may damage bone and cause other health problems. Ask before surgery about an implant’s track record. TJR is not usually recommended for people who have weak bones or who are obese.

Minimally Invasive TJR

What is it? 

This technique replaces a damaged joint, but uses shorter incisions than in a traditional TJR. Less muscle is cut and reattached.

Best candidates: 

Active normal-weight people younger than 50 years.

Pros: 

Less pain, less time in the hospital and quicker recovery than with conventional joint replacement.

Cons: 

These procedures are difficult and have higher complication rates than traditional TJR. 

Joint Revision

What is it? 

Surgery to remove a failed, infected or worn-out implant and replace it with a new one.

Best candidates:

People with a damaged artificial joint. Implants can last 20 years or longer, but those who get them as young adults may eventually need a revision.

Pros: 

Pain relief and improved mobility, strength and coordination.

Cons: 

Because of the alterations surgeons make to bones during an original joint replacement, revision procedures are more complex and less successful than initial replacement surgeries. Sometimes surgeons need to take a bone graft from another area to complete the operation. Possible complications include a higher fracture risk after surgery, and in the hip, twice the risk of dislocation and uneven leg lengths.