When Is Surgery Right?

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Rheumatoid Arthritis: When Is Surgery Right?

http://www.webmd.com/content/article/118/113062.htm?rp=refp_rctr_abbo_humh

Medicines for rheumatoid arthritis can slow down the disease, but after

joint damage has occurred, surgery may be a reasonable option. Advancements

in surgical treatment are giving people with rheumatoid arthritis more

chances to maintain function and keep moving.

Having surgery is never something to enter into lightly, but sometimes it

can really help. When is the right time for surgery for rheumatoid

arthritis, and what can you expect?

There are a couple of reasons to choose surgery for rheumatoid arthritis:

Relieving pain. Pain relief is the most consistent benefit of orthopedic

surgery.

Improving function. Repair or replacement of a weakened joint can help you

regain some of your previous activity level.

When Can Surgery Help RA?

The first question to ask your doctor is, can surgery help? When there is

structural damage to a joint or the tissues around it, medicines can't fix

it, and surgery may help. Determining whether surgery will fix a joint

problem is complicated and requires consulting with your rheumatologist and

an orthopedic surgeon.

The timing of surgery is also critical. Because any surgery is serious and

can have complications, in general it's delayed until really necessary. If

surgery is delayed too long, though, it can be less successful. Figuring the

optimal time to perform surgery requires close attention and consideration -

again, by both your rheumatologist and orthopedic surgeon.

There are several commonly performed surgeries that can help rheumatoid

arthritis:

Total joint replacement. The hip and the knee are the joints most often

replaced in people with rheumatoid arthritis. The damaged structures are

taken out, and an artificial joint (prosthesis) put in. The life of a

replaced joint is usually 10 to 15 years, depending on factors such as the

patient's physical condition, activity level, and body weight. After that

point, a second surgery is needed (revision surgery), which is more

difficult and the outcome is not generally as good. Therefore, the timing of

joint replacement surgery is critical.

Carpal tunnel release. This can relieve the pain of carpal tunnel syndrome

(compression of a nerve in the hand).

Fusion of cervical vertebrae. In some people with RA, instability of the

vertebrae in the neck can occur. Fusion makes the neck more stable and

avoids problems, such as nerve damage. It reduces flexibility, but this is

usually not a problem.

Synovectomy. This is the removal of the abnormal joint lining to prevent it

from eroding cartilage and bone. While effective, eventually the synovium

may grow back and the surgery may need to be repeated.

If you are a candidate for one of these or another surgical procedure to

help your rheumatoid arthritis, what can you expect? There are some things

to think about and steps you can take to make the surgery and your recovery

more successful.

What to Expect Before Surgery for Rheumatoid Arthritis

Your doctor may temporarily stop some of your medicines, in case they could

lead to immune system suppression that would make infection more likely.

You may need to stop aspirin or other blood-thinning medicines a week or so

before the operation.

Before knee or hip surgery, your doctor may have you practice walking on

crutches to strengthen your arm muscles.

You may need to give blood in advance in case you need it during the

surgery.

There are several things you can do to lower your risk of complications and

improve your recovery.

If you have any tooth or gum disease, have it treated before the surgery.

This helps prevent infection from bacteria in your mouth.

Report any discomfort with urination to your doctor. If you have a urinary

infection, it should be treated before the surgery.

Eat a healthy, balanced diet. This will give you the energy and nutrition

you need to heal faster.

Exercise. People with a higher fitness level do better after surgery.

If you smoke, quit! Stopping smoking reduces the risk of complications from

surgery.

Lose weight. Less weight means less stress on the artificial hip or knee,

making it last longer. Some surgeons will not perform joint replacement

surgery on a hip or knee unless a person is less than 300 pounds.

Prepare your home. You will need someone to help you with cooking, cleaning,

and shopping while you are recovering. Fall-proof your home by taping down

loose carpets or electrical cords.

What to Expect After Surgery for Rheumatoid Arthritis

You'll be in the hospital for a few days.

You can expect some pain and soreness, but pain medicines will control that.

Learn your physical therapy plan and stick with it when you get home. Don't

lie around! Practice walking every day.

Within three to six weeks, you should be getting back to normal light

activity.

Around this time, you'll see your orthopedic surgeon again to make sure

you're healing and progressing well.

It's also important to be realistic. Surgery can help, but it will rarely be

a perfect fix.

Complications of Surgery for Rheumatoid Arthritis

There usually aren't any complications after surgery, but it's important to

watch out for them just in case. Call your surgeon if you notice any of the

following:

The skin around the area of surgery becomes unusually red or hot.

The wound drains pus or thick, foul-smelling fluid.

A fever higher than 101 degrees.

Chest pain or noticeable shortness of breath.

Unusual pain or swelling of one leg.

For more information, visit the Arthritis Foundation's Surgery Center at

http://www.arthritis.org/conditions/SurgeryCenter/default.asp.