If you are thinking about surgery for your arthritis, here is what you need to know for what could be ahead. In this article, we take a look into some common surgical procedures so you can have a more informed conversation with your doctor.
Disclaimer: This is does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits.
Why decide to go for surgery?
When your regular exercise and medication stop working, your joint is far too damaged, you’ve loss movement and function in your joint and you’ve noticed your joint become very unstable, surgery might be on your radar.
Benefits of joint surgery include:
- reducing joint pain
- improving joint function
- preventing further joint damage
- reducing use of anti-inflammatory drugs
- improving mobility
- improving quality of life
When to talk to your doctor about surgery?
- If you have pain that stop’s you going to sleep at night.
- Your pain does not improve with rest, medicines, exercise or other treatments.
- Your affected joint/s make it challenging to:
- Shower
- Get dressed
- Cook and prepare meals
- Stand up or get out of a chair/bed and you require help from others for everyday tasks.
- Your condition makes it difficult for you to work, carry out basic household tasks or look after people who require your care.
- Your pain is preventing you from doing things you love and enjoy in life
What kind of surgical procedures exist for arthritis?
Let’s take a look at what they are and what they involve
Osteotomy
Involves cutting bone (and sometimes adding bone tissue) to reshape or realign your bones. The purpose of an osteotomy is to correct deformities, improve alignment, or alter the shape of a bone to relieve pain and improve function. The jaw, elbow, spine, shoulder, hips, knees, legs, toes and feet are common surgical sites. A Knee osteotomy is used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint.
The surgeon will perform an osteotomy if there is:
- An angle, bowing or rotation of your bones.
- Misalignment in a deformed or unjoined joint.
- Damage in the joint
- A need to shift your weight from a damaged area of a joint to an area where there’s more normal or healthy cartilage.
- Severe pain from osteoarthritis (especially in the knee and hip).
- A chance to delay the need for joint replacement surgery in younger, active people.
Synovectomy
Involves the removal of inflamed and bulky synovial tissue, which surrounds the joint capsule. By removing the diseased synovium, it may be able to slow down the progression of joint damage and improve overall joint function. A synovectomy is commonly performed on joints such as the knee, wrist, ankle, or elbow. The amount of inflamed synovium removed varies from patient to patient. It is indicated for inflammatory types of Arthritis like Rheumatoid arthritis and psoriatic arthritis.
The surgeon will perform a synovectomy if:
- DMARDS (disease-modifying anti-rheumatic drugs) have stopped working and do not improve the condition.
- Excessive synovial growth in the joints is present.
- When calcifications have formed in the synovium (Synovial chondromatosis)
- When there has been bleeding into their joint (hemarthrosis) without any external cause. Recurring episodes of bleeding can lead to chronic joint edema and disability (Hemophilla)
- Joint infection
Arthrodeisis (fusion)
Arthrodesis, is also known as joint fusion surgery. It is a surgical procedure that aims to permanently join two or more bones within a joint and remove the remaining cartilage and/or any disease joint tissue. The goal of arthrodesis is to eliminate joint movement and create a solid union between the bones. The bones are held in place with internal fixation devices such as screws, plates, or rods until the fusion is complete. It is generally considered for joints where mobility is less crucial, such as the ankle, wrist, or fingers.
The surgeon may perform joint fusion surgery if:
- When the joint in unstable due to ligamentous or structural damage and conservative treatments have not been successful in providing stability, arthrodesis may be performed to prevent further damage.
- joint replacement surgery is not feasible or appropriate due to loss of bone or affected by a tumour in the bone.
This surgery may not be appropriate for health issues, like:
- Poor bone quality
- An infection
- Narrowed arteries
- A nervous system (neurological) problem that may keep you from healing
Total joint replacement (Arthroplasty)
A total joint replacement, also known as arthroplasty, is a surgical procedure in which a damaged or diseased joint is replaced with an artificial joint (metal and plastic parts). The plastic acts like hard cartilage and the interlocking parts of the artificial joint allow for bending and movement. It is often a last option to treat persistent severe knee pain or disability after other options have been tried or considered. The goal of a total joint replacement is to relieve pain, restore function, and improve quality of life for individuals with severe joint conditions, such as advanced osteoarthritis, rheumatoid arthritis, or joint trauma.
The procedure involves removing the damaged joint surfaces and replacing them with artificial components made of metal, plastic, or ceramic. The prosthetic joint is designed to mimic the natural joint’s structure and function, allowing for improved mobility and reduced pain.
The surgeon may perform joint replacement surgery if:
- Joint pain hasn’t gotten better with nonsurgical treatments such as physical therapy (PT), medications, bracing, injections, walking assistive devices and rest.
- Joint stiffness and limited mobility that make it difficult or impossible for you to do your everyday activities.
- Swelling (inflammation) hasn’t improved with medications or lifestyle changes.
Do you know the risks?
All surgeries have risks. There are general risks associated with surgery and anesthesia, risks associated with the specific procedure and complications that can arise post-surgery. It is important that if you are deciding to have surgery, you discuss the risks thoroughly with your doctor and surgeon to understand their likelihood, potential consequences and what you can do to minimise them.
Some of the questions you may want to ask:
- What are the potential risks and complications specific to my condition and the type of surgery being recommended?
- How frequently do these complications occur in patients undergoing this particular surgery?
- Are there any factors that increase my individual risk for complications?
- What is the anticipated post-operative pain level, and how will pain be managed?
- What is the expected recovery timeline, and what can I do to optimize my healing and minimize potential complications?
- What is the success rate of this surgery in terms of pain relief and functional improvement?
- What signs or symptoms should I watch out for after the surgery that might indicate a complication, and when should I seek medical attention?
What to do to prepare for surgery?
- If you are getting ready for surgery, here are some general tips to help you prepare for it:
- Plan for recovery and returning home. Recovery, could take days, weeks or months, you may need help with daily tasks such as cooking and showering. Make sure you have support available to help you during this time. If you do not have help available, talk to your doctor about local support services or discuss organising a stay at a rehabilitation centre after surgery.
- Depending on what surgery you are getting, you may need to talk to a physiotherapist or occupational therapist about any equipment you may need, such as crutches and handrails in the shower.
- If your BMI >30, you may be encouraged to lose a little bit of weight if you are overweight or obese. This will not only help minimise the risk of complications during surgery, but help improve rehabilitation afterwards.
- Stop smoking and/or vaping.
- Increase exercise. People with greater fitness and muscle strength usually recover more quickly from surgery. If you have severe pain, you may find water exercise more comfortable – See Warm Water Exercise Classes
- You will probably need to follow a physiotherapy or exercise program after surgery. Be ready for several weeks or even months of exercise. Remember, the amount of effort you put into your program can make a big difference in how well you recover.
Mary Zagotsis
Health Educator
Arthritis NSW
June 2023