Everything You Need to Know About Psoriatic Arthritis Surgery

If you have psoriatic arthritis (PsA) and the condition has caused significant damage to your joints, your doctor may recommend surgical intervention. Typically, the surgery needed for psoriatic arthritis is total joint replacement surgery, in which the surgeon replaces damaged joints with durable plastic and metal parts.

Surgery is usually considered a last resort if other treatment options fail to work. However, PsA is an autoimmune and inflammatory form of arthritis, in which your immune system attacks your joints by mistake. The inflammation caused by the condition cannot be treated with surgery.

In this article, we'll discuss how psoriatic arthritis surgery is performed and the benefits and risks of the surgery.

What Is Psoriatic Arthritis?

Psoriatic arthritis is a progressive autoimmune disease that occurs in about 30% of people with an inflammatory skin condition called psoriasis. Like other forms of arthritis, it affects the joints. People with PsA may have joint pain before or after a psoriasis rash appears. Some people may not have any skin symptoms at all.

The joints most often affected in people with PsA are the neck, back, shoulders, elbows, wrists, fingers, knees, ankles, hands, and feet. PsA leads to bone damage, damaged cartilage, and inflamed joint fluid, which over time gets worse. Inflammation also worsens and, subsequently, limited treatment options are available.

Psoriatic Arthritis Doctor Discussion Guide

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When Is Psoriatic Arthritis Surgery Recommended?

PsA symptoms like joint pain and swelling can usually be managed with medications like nonsteroidal anti-inflammatory drugs (NSAIDs), and your doctor will prescribe disease-modifying anti-rheumatic drugs (DMARDs) to slow disease progression.

If your joints become severely damaged, your doctor may recommend total joint replacement surgery. Joint fusion and synovectomy are also commonly used to treat PsA. Joint fusion, also known as arthrodesis, is performed to hold a joint in a fixed position by fusing together the bones that make up the joint. It is usually reserved for joint damage in the hands, ankles, or spine.

A synovectomy can be conducted on any affected joint. It can help to delay total joint replacement surgery by removing the synovium, the membrane lining joints, and easing pain. Synovectomies can be performed on knee, hip, elbow, wrist or finger joints.

One study estimated that 40%–60% of people with PsA will need joint-related surgery for pain relief. It also found that at a 15-year follow-up after diagnosis of the condition, almost 30% of people with PsA received surgery.

Benefits and Risks of Psoriatic Arthritis Surgery

Surgery offers significant pain relief for severe cases of PsA. It can repair the damage the condition has done and allow you to participate in day-to-day life with improved symptoms.

Many prosthetic joints last for years. However, a prosthetic joint can wear out and become unstable. Your surgeon may schedule annual follow-up appointments to monitor the implanted joint and, if necessary, explore surgical options to repair or replace aging parts.

However, sometimes a joint replacement doesn't improve symptoms as much as expected. This is an unfortunate but possible circumstance and should be taken into account before you decide to get surgery. Also, while rare, there is a chance the replacement will have issues like dislocation.

Other things to consider before surgery are recovery time and postsurgical care. Recovery time depends on the extent of your surgery, the joint operated on, and your daily tasks. If you have a sedentary lifestyle and career rather than physically demanding ones, recovery periods can be shorter. A hip replacement surgery, for example, may take two to four weeks to recover, but times can vary.

To benefit the most from replacement surgery, pre- and postsurgical physical therapy (PT) is required. PT before surgery allows the therapist to get a better understanding of your needs and capabilities and how best to treat you after your operation.

What to Expect During Surgery

During joint replacement surgery, an orthopedic surgeon will remove damaged parts of the affected joint and replace them with artificial pieces.

After an anesthesiologist administers general anesthesia, your surgeon will make an incision above the affected joint. The surgeon will then remove the damaged bones and cartilage.

Two metal pieces are implanted to replace the movable joint, and a plastic spacer is inserted between them to ensure the joint has a smooth gliding motion. The incision is closed with stitches.

During joint fusion, your doctor will make an incision in the area of the affected joint. The surgeon will then compress the bones together and attach them with plates, nails, screws, or other hardware. They may also use a bone graft to repair and rebuild bones.

Synovectomy can be performed as an open surgery or arthroscopy, a less-invasive approach involving smaller incisions. During an arthroscopic procedure, magnified pictures from the camera are projected onto a television monitor in the operating suite, guiding the surgeon throughout the procedure.

Recovering from Psoriatic Arthritis Surgery

After surgery, your doctor may prescribe pain medications to ensure you are comfortable while you recover. You generally remain in the hospital overnight for observation.

When you are discharged, your doctor will give you a supportive splint to wear for at least two weeks. If your ankle joint is replaced, you will also need crutches during recovery to avoid putting weight on your foot and ankle.

Your doctor will schedule a follow-up appointment after 10–14 days to assess how well the affected joint is healing and to determine whether you need to continue to wear the splint. After the joint heals, your doctor may recommend four to eight weeks of physical therapy.

Depending on your health and abilities prior to surgery, the affected joints, and the success of surgery, recovery may be longer for some people than others. Joint replacement surgery recovery also depends on the job a person is returning to. If they need to be rehabilitated for physical, labor-intensive work, they may take longer to recover than a person returning to office work.

Additionally, PsA surgery can cause lingering pain. It is normal to have pain in the joint where surgery was performed. The pain can last a few weeks or months.

Summary

You may need surgery for psoriatic arthritis if your joints become severely damaged. Your doctor will often first recommend medical treatments to control the pain and slow disease progression before recommending surgery. The surgical interventions for psoriatic arthritis include total joint replacement surgery, joint fusion, and synovectomy. Your doctor will recommend a procedure based on your needs and the types of joints affected.

A Word From Verywell

Each person's experience with psoriatic arthritis is different. When considering if surgery is right for you, consult your doctor and go over the benefits and risks. If you are preparing for surgery, trust that your doctors have the experience and expertise to do the best job possible.

Follow pre- and postsurgical recommendations, such as attending physical therapy and not putting weight on the joints that were operated on, for the best and longest-lasting results.

Frequently Asked Questions

How else can you treat psoriatic arthritis before surgery?

Surgery is considered a last resort for the treatment of people with PsA. The first line of treatments includes over-the-counter medications such as nonsteroidal anti-inflammatory drugs like Advil (ibuprofen) and Aleve (naproxen) to alleviate the pain and inflammation, as well as prescription drugs like DMARDs (disease-modifying anti-rheumatic drugs) to slow disease progression. Steroid injections and lifestyle changes often are also recommended.

How long will recovery from psoriatic surgery be?

Total joint replacement has a relatively short recovery time, but recovery varies based on the individual and success of the surgery. Typically, recovery from joint replacement is two to four weeks. Joint fusion requires a longer recovery of up to 12 weeks.

Will psoriatic arthritis shorten your life expectancy?

Psoriatic arthritis is not life-threatening. However, due to the high possibility of comorbidities, other conditions that a person can have at the same time as PsA, such as cardiovascular and respiratory conditions, people with PsA may be associated with a reduced life span. But early treatment significantly improves a person's prognosis.