Arthroplasty for Rheumatoid Arthritis

Overview

Surgery can significantly improve function and relieve pain in cases when rheumatoid arthritis (RA) becomes very severe. Arthroplasty, or joint replacement, involves replacing some or all of the bones in a joint with plastic, ceramic, or metal components. The hips and knees are the joints most frequently replaced during arthroplasty. Arthroplasty may also be performed on ankles, elbows, shoulders, and fingers. Approximately 25 percent of people with RA will eventually undergo arthroplasty for at least one joint.

Arthroplasty may become a choice if medication no longer controls RA symptoms, if pain becomes intolerable, or if you can no longer perform your usual daily tasks.

Arthroplasty is not a cure for RA, and it does not prevent future disease activity.

What does it involve?
Your doctor may order a complete physical, blood tests, or other diagnostic procedures to ensure that you are in good condition for surgery.

Once your arthroplasty is scheduled, spend the weeks before surgery preparing by eating nutritious meals and staying as active as possible. Stop or cut down your smoking, and limit your consumption of alcoholic beverages to one or two per day. Being in top condition for surgery will shorten your recovery time and help prevent complications.

You will be given instructions to stop eating eight hours before surgery. When you arrive at the hospital, vital signs will be taken, and blood may be drawn. Before surgery, you will receive an intravenous (IV) line. Depending on the type of arthroplasty you are receiving, you may receive medication to relax you, but remain awake during surgery, or general anesthesia to make you sleep.

The technique used during arthroplasty depends largely on which joint is being replaced. During arthroplasty, diseased portions of bone and cartilage will be cut away. Bones may be reshaped. The surgeon will then replace part or all of the joint with prosthetic components made of metal, plastic, or ceramic.

Depending on your condition and the surgical technique used, you may spend between two and 14 nights in the hospital recovering from arthroplasty. The nurse or doctor will explain how to care for your wound. You will begin rehabilitation exercises early in recovery. It may require weeks or months to rehabilitate your new joint fully. Completing your rehabilitation program is key to a successful arthroplasty.

Intended Outcomes
Arthroplasty can reduce pain and restore function, making it possible to return to performing normal daily tasks.

Results
Arthroplasty can provide significant improvements in pain, function, and quality of life for those with severe rheumatoid arthritis.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Arthroplasty can be painful, and you will most likely need pain medication for some weeks during recovery.

Blood vessels or nerves may be damaged during arthroplasty, resulting in weakness or numbness. The prosthetic joint may become loose or dislocated after the surgery.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.

Even if your arthroplasty is successful, there is a chance it may not relieve your pain or improve your ability to perform daily functions.