Why Is Joint-replacement Surgery Used for PsA?

Psoriatic arthritis can cause significant and permanent joint damage, causing pain and limited range of motion in the affected joints. In severe cases of psoriatic arthritis, surgical care may be indicated. Arthoplasty is the term that includes any surgical procedure that restores function of the joint, which can include joint replacement, realignment or resurfacing of the bones in the joint. The need for surgery is determined by the inflammation and erosive changes as seen on x-rays, as well as significant pain and loss of function of the affected joint.1,2

Orthopedic surgeons perform joint surgery. Orthopedic surgeons are specialists who focus on injuries and diseases of the body’s musculoskeletal system, including the bones, joints, ligaments, tendons, muscles, and nerves that allow movement.1,3

According to a review of the medical literature on orthopedic surgical procedures in psoriatic arthritis, the most common operation on patients with psoriatic arthritis is hip surgery, with 50% of those being total hip replacement. One-third of patients undergoing hip surgery had bilateral hip replacements (both hips). The second most common orthopedic procedure in psoriatic patients is knee surgery, and approximately 25% of patients who undergo hip surgery also have knee surgery, and 50% of those had bilateral knee replacements (both knees).2

Types of surgery to joints affected by psoriatic arthritis

There are several surgical procedures that are used on people with psoriatic arthritis, depending on the severity of the joint damage and the patient’s health. The goal of surgery is to obtain the most predictable results, achieve the greatest pain relief, and preserve the maximum degree of function and independence. Some of the surgical interventions that are routinely used include:3,4

  • Total joint replacement – In a total hip replacement, or a total 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, and 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.3
  • Synovectomy – Synovectomy removes part or all of the joint lining (synovium) and is effective when the disease is limited to the joint lining.3
  • 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.3,4

Risk of postoperative complications

Some research documents that patients who undergo joint surgery for psoriatic arthritis have an increased tendency for postoperative infection, both superficial (on the skin) and deep. This increased risk of infection is believed to be connected to the presence of high numbers of bacteria on psoriasis plaques, which often accompany psoriatic arthritis. Other studies have shown no significant increased risk with patients with active psoriasis having no significant wound-healing complications.2

Another postoperative complication is flares of psoriasis in the region of the surgical scar. More common postoperative complications in psoriatic arthritis patients include postoperative stiffness and development of recurrent deformity of the joints, particularly in the hand. These complications are believed to be the result of the involvement of surrounding tissues in the chronic inflammatory process caused by psoriatic arthritis. Rehabilitation and physical therapy focusing on range of motion is essential for maintaining joint function following surgery.2

Written by: Emily Downward | Last reviewed: October 2016.
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