he mRheumatoid arthritis (RA) can lead to disability and significant deformities in some people, especially those with an aggressive disease course. When less-invasive options have not been effective, surgery might be the only option to reduce joint pain and improve mobility. Several types of orthopedic surgeries are used in RA patients.
Joint Replacements
Much like osteoarthritis, joint replacements may be used when a joint is extensively damaged. The most common joint replacements seen in RA patients are knees, hips, and shoulders. There is some variation in the type of joint replacements, such as partial or complete replacements. For example, in a partial knee replacement, only one side of the joint is supplemented with an artificial joint, whereas a complete replacement replaces both sides. The type of joint replacement is contingent upon where the damage is located.
With RA, there can be additional challenges with joint replacements because the underlying disease process can damage supporting structures, making it necessary to do additional repairs before a replacement would be successful. Also, since people with RA often take medications to suppress parts of the immune system to slow disease progression, their risk of infection might be higher or steroid use might have weakened the bones, further complicating the procedure.
Joint Fusions
Joint fusions are more frequently used in smaller joints, such as the fingers and toes, that have deformities. When deformities are caught early, it may be helpful to splint the finger or toe, which may prevent the deformity from becoming fixed. Once the deformity is in a fixed position, it cannot be straightened without surgery. During a joint fusion, the damaged bone is removed and the two bones are held together with orthopedic hardware. Sometimes a bone graft could be necessary to encourage the bones to fuse together.
Another joint that can benefit from fusion surgery is the sacroiliac (SI) joint, which is where the pelvis and lower spine meet. Some people with RA eventually develop hypermobility in this joint and the supporting structures weaken. Generally, physical therapy is the first treatment approach. Regular exercises might be helpful in strengthening the surrounding muscles, which can reduce the movement of the SI joint. The last treatment option is fusing the SI joint. Small holes are drilled on either side of the joint and pins are inserted to hold the bones together. The pins are hollow to allow a bone graft. Fusing the SI joint can be challenging, since the joint naturally moves a small amount and hypomobility can also cause pain and inflammation.
Cervical Spine Stabilization
RA affecting the cervical spine is not uncommon. In rare cases, the ongoing inflammation may severely affect the cervical spine to the point it becomes unstable. The part of the cervical spine that is affected by RA is the C1-C2 junction, or where the skull rotates on the cervical spine. To prevent compression of the spinal cord and other life-altering complications of an unstable cervical spine, surgery to stabilize the vertebrae is necessary. Metal rods and other supporting hardware may be used to stabilize the vertebrae. In many cases, this can provide the necessary support without having to resort to complete fusion of the vertebrae. The goal is to provide stability but still allow the patient to retain some movement of the cervical spine so they can move their head. In some circumstances, it may be necessary to eliminate the range of motion of the head to adequately fix the instability.
Since RA can be an aggressive autoimmune disease that is difficult to treat, even after trying different medications, surgery may be necessary to repair or replace joints. Although surgery can be intimidating, the reduction in pain and better mobility can improve the quality of life for many RA patients. Talk to an orthopedic surgeon near you to learn more.
