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.

Arthroplasty is a procedure that restores joint function

This can include joint replacement, realignment, or resurfacing of the bones in the joint. The need for surgery is determined by the inflammation and damage seen on X-rays. Pain and loss of function of the affected joint are also considered.^1,2

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 that allow movement.^1,3

Research shows that hip surgery is the most common procedure in people with PsA. Half of these surgeries are total hip replacements, while 33 percent are bilateral hip replacements (both hips).

Knee surgery is the second most common procedure in people with PsA. Roughly 25 percent of people who have hip surgery also have knee surgery. Half of those have bilateral knee replacements (both knees).²

What are the goals?

The type of surgery used depends on the severity of the joint damage and your overall health. The goals of surgery are to get the most predictable results, achieve the greatest pain relief, and preserve as much function and independence as possible.

Surgeries that are commonly used in people with PsA include: ^3,4

• Total joint replacement – In a total hip or knee replacement, the damaged bone is removed and replaced with metal or ceramic. The damaged cartilage surface is also removed and replaced with a metal socket. Screws or cement are used to hold the socket in place. A plastic, ceramic, or metal spacer is inserted between the pieces to allow for a smooth gliding surface.
• Synovectomy – This procedure removes part or all of the joint lining (synovium). It is effective when the disease is limited to the joint lining.
• Joint fusion – Joint fusion (or arthrodesis) eliminates the joint by fastening the bones together using pins, plates, screws, or rods. This eliminates the joint’s flexibility but can reduce pain.

Surgey often comes with risk

Some research shows that people who have surgery for PsA are more likely to have an infection after the procedure. This includes infections that are on the skin (superficial) and deep.

Doctors think this risk is linked to the high number of bacteria on psoriasis plaques. These plaques are common in PsA. Other studies have found no major increased risk for wound-healing complications in people with active psoriasis.²

Other common complications include:²

• Flares of psoriasis around the surgery scar
• Stiffness
• Return of the joint deformity, especially in the hands

Doctors think that chronic inflammation caused by PsA leads to these complications. Physical therapy focusing on a range of motion is key to maintaining joint function after surgery.²