Why Is Joint-Replacement Surgery Used for Psoriatic Arthritis?

Psoriatic arthritis (PsA) can cause significant and permanent joint damage. This causes pain and a limited range of motion in the affected joints. In severe cases of PsA, surgery may be needed.¹

What is joint replacement surgery?

Joint replacement surgery, also called arthroplasty, involves removing a damaged joint and replacing it with an artificial one. The artificial joint, called a prosthesis, is designed to mimic the movement of a natural joint. It can be made from materials like metal or plastic.^1-3

Orthopedic surgeons perform joint surgery. Orthopedic surgeons are specialists who focus on injuries and diseases of the body’s musculoskeletal system. This includes bones, joints, ligaments, tendons, muscles, and nerves involved with movement.^2-4

How does joint replacement surgery help with PsA?

For those with PsA, this surgery can help relieve pain, improve joint function, and enhance overall quality of life. The overall goals are to reduce pain and increase mobility.^1,3,4

Types of joint replacement surgery for PsA

Joint replacement surgeries for PsA most commonly occur in the:^3,4

• Hips
• Knees
• Feet and ankles

There are several types of surgery used to treat PsA:^3,4

• Total joint replacement – In a total hip or knee replacement, the surgeon removes the damaged bone and replaces it with metal or ceramic. The damaged cartilage surface is also removed and replaced with a metal socket. Screws or cement hold the socket in place. A plastic, ceramic, or metal spacer inserted between the pieces allows them to glide smoothly.
• Synovectomy – This procedure removes part or all of the joint lining (synovium). It is effective when PsA is limited to the joint lining.
• Joint fusion – Joint fusion (arthrodesis) eliminates the joint by fastening the bones together using pins, plates, screws, or rods. This makes the joint unable to flex but can reduce pain.

When is surgery considered?

Doctors consider surgery if the person with PsA has significant joint damage that prevents them from doing simple tasks and taking part in everyday activities. The need for surgery is also determined by the inflammation and damage seen on X-rays.^1-4

What are the possible side effects?

As with any surgery, there is some risk involved in joint replacement surgery. People who have surgery for PsA may have an increased risk of infection after the procedure. This may be caused by flares of psoriasis (skin lesions) on the skin triggered by the surgery. But with appropriate preparation of the skin area, these infections can be avoided.^3,4

Other complications can occur as well. Chronic inflammation caused by PsA may be a reason for some of these complications. They can include:^3,4

• Flares of psoriasis around the surgery scar
• Blood clots
• Joint stiffness and weakness
• Nerve damage

These are not all the possible side effects of joint replacement surgery. Talk to your doctor about what to expect with joint replacement surgery. You also should call your doctor if you have any questions or concerns about joint replacement surgery.

Other things to know

Some biologic medicines used to treat PsA can hinder the healing process after surgery. Talk with your doctor about whether they recommend adjusting your medicines before and after surgery.³

Because PsA is an autoimmune condition, surgery does not help to reduce inflammation in the body. Inflammation caused by PsA should still be treated appropriately.^1,3

After joint replacement surgery, you will need to take time to fully recover. Make sure you are following the recovery instructions given to you by your doctor. Physical therapy is key to maintaining joint function after surgery.²