How Arthritis Works

Surgical Arthritis Treatments: Time for the Operating Room

Your X-ray after a hip replacement might look a little something like this.
Your X-ray after a hip replacement might look a little something like this.
© iStockphoto/33karen33

Sometimes standard treatments aren't effective for people with arthritis. For these cases, there are surgical options to aid in pain relief and mobility and to correct joint disfigurement or deterioration.

In some cases, arthroscopy -- cutting out damaged tissue and debris from your joint through a small incision -- may provide a great deal of somewhat temporary relief. (Rheumatoid arthritis, unfortunately, can't be cured through this or any other procedure.) Arthroscopy is a relatively minor procedure, and it allows surgeons to smooth out rough joint surfaces and clean out bits and pieces of tissue or foreign matter that are floating around in the joint. Likewise, a synovectomy allows surgeons to cut out and remove portions of the joint's inflamed synovium that aren't responding to DMARDs.

There are a number of operations that can be performed on the hands and fingers. Surgeons can repair or reattach damaged tendons, or they can cut them in order to allow greater range of motion. Ligaments in the hand can also be cut (as they are in carpal tunnel procedures) if the ligament is squeezing a nerve along the middle of the wrist. Joints in the fingers may be capped with plastic or metal components or can be fused entirely together to provide relief (with the disadvantage of diminished mobility).

The vertebrae can also be connected through bone grafts or man-made connective materials. Once held in place, new bone grows, stabilizes and strengthens the fused bones. Surprising as it may seem, many people with fused vertebrae don't lose any flexibility or range of motion in their backs.

Cases in which bones and cartilage have undergone great damage may call for total joint replacement. Knees, hips, fingers, thumbs, shoulders and ankles are among the joints that can be removed and replaced by artificial implants. The implants may be screwed onto the bone end or attached with a special type of cement. Joint replacements come with their own share of problems -- sometimes the new joints must be removed if they don't fit correctly or if an infection develops. In many cases, though, patients with artificial transplants feel a great deal of relief from what had often been constant agony.

In cases of deformity caused by constant inflammation, doctors will attempt to correct the problem using nonsurgical splints. If that doesn't work, the joint can be surgically realigned.