Psoriatic arthritis (PsA) is a type of arthritis that affects about 30 percent of people with psoriasis, a skin condition that causes inflamed, raised rashes. Psoriatic arthritis causes chronic pain and inflammation in the joints of the hips, knees, back, hands, feet, wrists, ankles, and neck. It also leads to damage in the cartilage, bones, ligaments, and synovium (the connective tissue inside a joint).
If your joint pain and swelling don’t respond to other treatment options, such as medication and lifestyle changes, your doctor may recommend joint replacement surgery. Although joint replacement surgeries can improve quality of life for people with severe forms of psoriatic arthritis — such as psoriatic arthritis mutilans — they do not treat inflammation.
Some people with severe joint damage and pain may need joint replacement to restore full range of motion and relieve pain in the affected joints. Several types of joint surgery can treat psoriatic arthritis. The type your doctor will recommend will depend on which of your joints are affected and the severity of your pain.
Following are the most common types of joint surgery for psoriatic arthritis:
A doctor may recommend a synovectomy if your synovium is inflamed and creates too much fluid. This causes cartilage damage, leading to pain and stiffness in the joint. A synovectomy is often done to delay the need for total joint replacement.
Arthrodesis surgery entails fusing bones of a joint together in a fixed position. It’s most commonly performed in the hands, feet, ankles, or spine. Joint fusion helps keep the joint stable and reduce joint pain, but it can reduce mobility.
If your joints are out of alignment, your doctor may recommend an osteotomy. The surgery may entail reshaping or moving bone in your joints to improve mobility. In some cases, bone tissue may be added to align the joints.
During a debridement procedure, damaged bone tissue found in areas surrounding damaged joints is removed. The damaged tissue may be replaced with bone tissue from another part of the body.
Tissue reconstruction involves repairing ligaments and cartilage in the affected joints.
Also called joint replacement, arthroplasty is recommended for late-stage psoriatic arthritis. During this surgery, the damaged joint is replaced by an artificial joint made with durable plastic and metal parts. The most common is total hip replacement, followed by knee replacement.
To prepare for a joint replacement surgery, it’s recommended that you exercise to build muscle strength and achieve the lowest weight you can, to reduce stress on the joints. One member of MyPsoriasisTeam gave this advice to another member planning to have a knee replacement surgery: “Just strengthen your leg muscles as much as possible beforehand.”
On the day of your surgery, you’ll be placed under general anesthesia. An orthopedic surgeon will make an incision above the joint to be replaced, then remove the damaged bone and cartilage. They’ll insert two metal pieces in place of the damaged joint and put a plastic spacer between the two metal pieces to allow smooth gliding. Then, the surgeon will close the incision with stitches.
Generally, a person stays at the hospital following surgery for monitoring and may be prescribed medications to manage pain during recovery. Once discharged, you’ll wear supportive splints to prevent dislocation. If the ankle joint was replaced, you may have to use crutches to reduce the amount of weight on the foot and ankle.
As with all surgeries, there are some risks associated with joint surgeries for psoriatic arthritis. Risks include:
In some cases, the stress from the surgery may lead psoriatic arthritis symptoms to worsen.
In the days after the surgery, you may need assistive and safety devices, including a walker, cane, crutches, shower seats, bathroom handrails, elevated toilet seats, and reaching devices. Your doctor will examine how the affected joint is healing in a follow-up visit 10 to 14 days following the surgery. Doctors recommend four to eight weeks of physical therapy to help recovery once the joint has healed. Recovery time varies depending on the joint affected, the activity level you are returning to, your general fitness before the surgery, the type of surgery, and how well the surgery went.
Generally, recovery from hip replacement takes about six weeks to three months. Recovering fully from knee placement generally takes about three months. In most cases, the artificial joints will last for years, but you’ll need to have regular checkups with your health care provider to look for wear or other problems.
Joint surgery relieves pain and repairs damaged tissues, improving the quality of life in most people with advanced psoriatic arthritis. But, in some cases, bone spurs — hard, smooth bumps of extra bone along bone edges — may form, affecting the structure of the joints. So, it is important to properly manage psoriatic arthritis even after surgery to prevent further damage. Here are things you can do:
Many MyPsoriasisTeam members have emphasized the importance of staying active, continuing physical therapy, and avoiding things that trigger inflammation. One member shared what has worked with pain relief: “Changing exercise routine, physical therapy adjustments, and finding triggering foods have added a bit more relief.”
A second member said, “Stretching whenever possible and range of motion exercises are musts, even at rest.”
A third member gave this advice: “Staying in one position for a long time affected my back pain, whether on my office desk or on the couch. Stay active — using a smartwatch with a reminder to stand up helped me.”
MyPsoriasisTeam is the social network for people and their loved ones with psoriasis and psoriatic arthritis. More than 117,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriatic disease.
Have you had joint replacement surgery for psoriatic arthritis? Share your experience and advice in the comments below or by posting on MyPsoriasisTeam.