Most people with rheumatoid arthritis do not require surgery. However, it may be considered if a joint is badly damaged or if pain is severe and difficult to control using drugs. Before surgery is considered a whole range of treatment options have usually been tried including painkilling and disease modifying drugs and other treatment like physiotherapy.

Doctors will only recommend surgery when the pain and disability are having a serious effect on a person’s daily activities. In this case, your rheumatologist will refer you to an orthropaedic surgeon, who will discuss the options with you.

The basic goals of surgery in rheumatoid arthritis are to relieve pain, restore function, correct any deformity and prevent joints from deteriorating further.

With osteoarthritis, joint surgery is of great benefit as it often restores movement and relieves pain. However, as rheumatoid arthritis affects more than one joint and smaller joints than osteoarthritis, it is difficult to surgically treat.

Surgery may help in suitable cases, but is not likely to return the joint to normal.

There are a number of different types of surgery available from minor procedures to complete joint reconstruction:

Synovectomy

This surgery involves removing the inflamed lining of the joint cavity.

Anthroscopy

This surgery is minor in comparison to joint replacement and involves removing debris or inflamed tissue in a joint through a small-lighted instrument.

Tendon reconstruction

This surgery type involves removing the painful coverings from tendons or repairing damaged tendons.

Total joint replacement

This is major surgery, which involves replacing a badly damaged joint with an artificial joint. It is performed to relieve pain and improve function. Knee and hip joints are the most common joints to be replaced with rheumatoid arthritis. However, most hip replacements in Ireland are to help those with osteoarthritis.

The replacement parts can be plastic (polyethylene), metal or ceramic. Depending on an individual’s weight, activity level and other individual factors, artificial joints usually last about 10-15 years. However, newer materials are extending the lifespan of artificial joints, but these replacements can eventually wear out. Young people undergoing surgery should be made aware that their artificial joint may need replacing in the future.

After surgery, you will need to learn how to move freely with the new joint. A physiotherapist and sometimes an occupational therapist will be involved in advising you after surgery.