Surgery
Surgery may be necessary for patients with severe rheumatoid arthritis that cannot be controlled by drug treatments. Surgery aims to relieve the pain of the affected joints, to restore mobility and to reduce deformity. Several types of surgery can be used in rheumatoid arthritis:
Arthroscopy
This is keyhole surgery that involves examining the inside of the joint with a tiny camera. Small repairs to the joint can be carried out at the same time, including a procedure known as a synovectomy, where the inflamed synovial membrane that is responsible for rheumatoid arthritis is removed. It can, however, grow back.
Joint replacement
This involves removing the damaged joint and replacing it with an artificial one made from metal or plastic. It is most common for large joints such as the knee and hip but it can also be carried out on the small joints of the hands and ankles. The joints will no longer cause any pain and will be able to move freely. Joint replacements generally last 10–15 years.
Joint fusion
Joint fusion, or arthrodesis, involves permanently fusing the bones of a joint together. The joint will no longer be painful and will be very stable but it will not be able to move at all. It may be suitable for small joints in the fingers and toes, and for joints in the neck, which can cause life-threatening nerve compression if they become unstable.
