Rheumatoid arthritis (RA) is a chronic condition that may result in pain, swelling, and stiffness in the joints. In some cases, a doctor may recommend surgery to repair damaged joints, correct issues, and reduce pain. A total joint replacement, called arthroplasty, is a surgical option to help restore the function of a joint.
Although medical treatments can help slow the progression of RA and alleviate the symptoms, some people may still require surgery to ease joint pain and improve mobility. Arthroplasty, or joint replacement surgery, is a procedure that usually involves the replacement of a damaged joint with an artificial one. Knee and hip arthroplasties are the two most common types of arthroplasty.
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In this article, we discuss who may require an arthroplasty due to RA. We also look at the benefits and risks of the surgical procedure.
Arthroplasty is a procedure to reduce pain and restore functionality to a joint. RA is a chronic inflammatory condition that can result in joint damage that may lead to disability. As with any joint in the body, chronic RA can result in the destruction of both the knee joints and hip joints.
A doctor may initially try to treat the symptoms with nonsurgical options, such as disease-modifying antirheumatic drugs (DMARDs). However, joint replacement surgery may be necessary if these other options do not prove effective.
Before recommending surgery, a doctor will evaluate the medical history, overall health, and functional capability of the person and use X-rays to determine whether arthroplasty is necessary. In some cases, they may also use other imaging scans, such as MRI, CT, or bone scans, to evaluate the damage to the joint.
Arthroplasty has several potential long-term benefits, including a reduction in pain and an increase in mobility. Joint replacement therapy can help improve quality of life and enable most people to resume their daily activities and hobbies.
A 2022 article suggests that in addition to the above, arthroplasty may help increase life expectancy and improve cognitive function. However, many factors may contribute to these potential benefits.
As with any other operation, arthroplasty can pose certain risks and complications. However, evidence suggests that serious complications occur in less than 2% of people.
Some of the possible risks of arthroplasty include:
- Anesthesia: Although anesthetics are relatively safe, they may cause minor side effects, such as confusion and sickness. Major risks of anesthesia are rare but can include cognitive dysfunction, malignant hyperthermia, and breathing problems.
- Infection: Infection of the wound can occur within days or weeks of the surgery. Antibiotics can treat minor infections, but major infections might require further surgery.
- Blood clots: Blood clots are one of the most common complications of arthroplasty. These clots may give rise to serious conditions if they break free and travel to the lungs, causing a blockage.
- Implant problems: Implants can wear out or become unstable, or certain components can become loose. In such cases, people might need another surgery to replace the implant.
- Persistent pain: Although it is rare, some people continue to experience pain after the surgery.
- Nerve damage: Surgery can sometimes cause damage to the nerves and blood vessels. A second surgery can help repair the damage in such cases.
- Allergic reaction: Some people can have an allergic reaction to the components of the implant, leading to swelling, blisters, and rashes.
A person may be at risk of additional complications, depending on their overall health status and existing medical conditions. They should discuss any concerns with the healthcare team before undergoing surgery.
Before undergoing surgery, a person will attend a pre-op appointment to ensure that they are healthy enough to undergo the procedure. They may need to undergo certain tests, such as:
- a physical exam
- blood tests
- urine tests to rule out infection
- an electrocardiogram (EKG) to check heart health
- blood pressure checks
People undergoing surgery may also need to sign a consent form that will describe the procedure in detail. They must go through the form thoroughly and can raise any questions with the surgeon.
Ahead of an arthroplasty, it is advisable to inform a doctor about any allergies and current medications. A person should also make the doctor aware if they have a history of blood clots or if they suspect that they might be pregnant.
A doctor will provide instructions prior to the surgery, which may include fasting before the operation. They might also discuss the benefits and risks of sedation with the person. The individual may also meet with a physical therapist to discuss rehabilitation.
It may also be useful to prepare some home arrangements to ensure easy recovery. These arrangements may include:
- getting a family member or friend to help around the house for a few weeks after the surgery
- purchasing or borrowing a cane, walker, or crutches
- securing handrails or safety bars in the bath or shower
- making sure that a stable chair with a firm seat cushion is available
- getting rid of all loose cords
- placing frequently used items within easy reach
Total joint replacement surgery usually takes a few hours. Both knee and hip replacement surgery typically take 1–2 hours. In most cases, the surgery takes place under general anesthesia. However, it can sometimes take place under regional anesthesia instead.
The surgeon will clean the area of surgery before making the incision. Following this, they will remove the damaged bone and cartilage and replace them with the new metal, plastic, or ceramic prosthetic implant. After the surgery, a healthcare team will monitor the individual in the recovery room before transferring them to a hospital room or discharging them.
In many cases, people are able to return home about 4 days after the surgery. Recovery and rehabilitation will vary for each person and will largely depend on how well they follow the surgeon’s instructions regarding home care. For most people, 90% of recovery occurs within the first 6 weeks.
During the hospital stay, people will receive medications that provide short-term pain relief after surgery. Most people will also need physical therapy after surgery. A physical therapist will teach them certain exercises that strengthen their movement to help them resume their daily activities as soon as possible.
Recovery at home
Following the doctor’s suggestions for at-home self-care for a few weeks after surgery also ensures a quicker recovery. They may advise:
- avoiding soaking the wound in water until healing is complete
- following a strict diet and using iron supplementation to help with potential blood loss from the surgery
- doing specific exercises to restore movement
- walking to increase mobility
Most people undergoing joint replacement surgery can typically return to their usual activities after a relatively short period of recovery. For example, people can return to work and also start driving within 4–6 weeks of knee surgery or 6 weeks after hip surgery. However, the speed of recovery can depend on several factors, including the type of surgery and a person’s general health and overall fitness.
Most people undergoing arthroplasty experience reduced pain, improved motion and strength, and a better overall quality of life. Most people can also expect their joint replacement to last for many years. Research suggests that
Rheumatoid arthritis is an autoimmune condition that can result in inflammation and damage to the joints. The initial treatment will typically involve nonsurgical options to help reduce pain and improve mobility. However, if these approaches prove ineffective, a doctor may recommend joint replacement surgery, also known as arthroplasty.
Arthroplasty is a surgical procedure that involves removing the damaged joint and replacing it with a prosthetic. A person can usually recover and return to their usual activities within a few months. In many cases, arthroplasty can improve a person’s quality of life. The prosthetic implant often lasts for many years.