Surgery for arthritis

The thought of undergoing surgery often puts many people off but it is a good alternative to conventional forms of treatment which is also very effective as well.

Surgery is often recommended in severe arthritis cases or where conventional forms of treatment have failed to ease the symptoms and prevent the further spread of this condition.

Surgery is not a cure for arthritis but it can slow down the rate at which the disease is spreading as well as treat affected joints. Sometimes, it is the only option remaining to you.

Surgery can relieve the pain and misery caused by arthritis which will improve your quality of life. But there are several issues to consider before going ahead with this.

Most popular forms of surgery for arthritis

The most popular forms of surgery are:

• Knee replacement surgery
• Hip replacement surgery
• Shoulder and elbow joint replacement surgery
• Hand and wrist surgery
• Other surgery

Other surgery includes hip resurfacing, removal of the synovium (synovectomy), arthroscopy and fusion. It also includes procedures specific to a particular form of arthritis such as a Cheilectomy for hallux limitus (arthritis in big toe joint).

These are the main procedures performed on various forms of arthritis such as rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

This section includes information on whether you are suitable for surgery: the pros and cons of surgery: private or NHS: exclusions for surgery: making a decision and preparing for surgery.

Is surgery right for you?

But there are pros and cons to surgery so it is important that you consider these carefully before making a decision. Surgery is both safe and effective have a look through this section to see if it is the right choice for you.

Speak to your GP about surgery. Ask his/her advice about the various procedures and what you can expect. Don’t forget to ask about the risk as well as the benefits.

What you need to consider is the possibility of needing further surgery later on in life. If you are a young person or middle aged then there is a chance that you will need ‘revision surgery’later in your life.

The artificial joints used in replacement surgery last for up to 15 years following surgery but this depends the patient and their lifestyle. Generally younger people have more active lifestyles than older people which mean that their replacement joints wear out more quickly.

There have been advances in the materials used in joint replacement and new techniques have been developed. But there is always a chance that further surgery will be required.

Advantages of surgery

These include:

• Relieves pain and discomfort
• Relieves stiffness in the affected joint
• Improved flexibility
• Improved mobility
• Prevents further deterioration of the affected joint
• Improved physical and mental wellbeing

For many people having surgery means a new lease of life.

Disadvantages of surgery

All surgery has risks although these are very small. Nevertheless, it is important that you are made aware of these before making an informed decision.

These include:

• Revision surgery will be required at a later time in life
• Long and sometimes painful recovery period
• No guarantee of a return to full mobility
• Infection
• Blood clot (thrombosis)
• Damage to the nerves, veins or arteries surrounding the joint (very rare).

Take these into account when weighing up the pros and cons.

Surgery: NHS or private?

This is a personal decision. Surgery for arthritis can be done on the NHS but it means going onto a waiting list beforehand.

However, waiting times for surgery have reduced to around 18 weeks from the time of your referral by your GP through to the date of your surgery.

If you prefer not to wait then you have the option to ‘go private’which means paying for treatment. The advantage of this is that you will be seen a lot sooner but it is expensive.

If you have private health insurance then this may cover the cost of surgery for arthritis but check the terms and conditions of your policy. Not every policy pays for this and whether it will do so depends upon the type of policy you originally took out.

Plus there is the issue of a ‘pre-existing condition’. Pre-existing conditions are usually not covered by medical insurance and many providers will not pay out if you developed a condition before taking out a policy.

Speak to your insurer about this.

Making a decision

You need to have a clear understanding of what the surgery will entail; how long the recovery will take and what the likely outcome will be.

Ask the specialist (who will be a surgeon) about his/her success rates and years of experience. Also ask about the level of pain you may expect after surgery and the range of mobility you will have.

It is a good idea to prepare a list of questions to take with you when you meet with the consultant. Make a note of the answers and don’t be afraid to ask the same question more than once or if you do not understand anything.

Suggested questions include:

• How long will my replacement joint last?
• What can I expect after this surgery?
• Will I need revision surgery?
• What happens if it unsuccessful?
• How can I help my recovery?
• How long will I be off work?
• How soon will it be before I can drive/play sport/resume normal activities?
• What aftercare is available?
• What are the alternatives to this surgery?

You also need to consider what will happen during your recovery. This often a long period of time so you need to think about work and how you will manage during this time.

Exclusions for surgery

A discussion about surgery and the decision will be made between you and your GP. If you are suitable then your GP will refer you to a consultant who will put you on a waiting list.

But not everyone is a suitable candidate for surgery. There are several reasons why someone will be advised against surgery which include:

• Overweight or obese
• Medical conditions such as heart disease, lung disorder or a hyperactive form of arthritis.
• Ulcers
• Foot infection

Your medical history will be looked at during your appointment with your GP. If you have suffered from an illness or injury which could increase the risks during surgery then this may exclude you.

If you are advised against surgery then there will be a good reason for this. Your GP is first and foremost concerned with your health and it is vital that you are in good shape before undergoing any procedure.

There is an increased risk of something going wrong during surgery if you are overweight or obese: this excess weight puts a strain on not only your joints but internal organs such as your heart which are already under pressure during the operation. Any additional pressure can be dangerous.

Your GP will recommend alternatives if you are not suitable for surgery.

Preparing for surgery

If you decide to opt for surgery then you will go ‘into the system’which starts with your GP referring you to a consultant. This will be an orthopaedic specialist who will discuss your treatment with you as well as carrying our tests, e.g. X-rays.

If you are having surgery on the NHS then you will be placed on his/her waiting list.

If you choose to pay for treatment then you need to find a private clinic and consultant. Choose a reputable clinic which is concerned with your health above other considerations.

You will be provided with a set of instructions about preparing for surgery. This includes advice about when to have your last meal, what to bring with you and what will happen on the day.

You will be given a date for your surgery which involves admittance to hospital. Questions will be asked about your health and you will undergo a series of tests, e.g. blood tests as well.

If you are taking any medication then mention this beforehand. This may be changed before your surgery or stopped for a short period of time.

If you receive any social security benefits then notify DWP about your surgery. Make sure you do this before you go into hospital.

Arrange for time off work with your employer and make sure that you do this well in advance of your surgery. Also devise a plan for your return to work and mention this as well.

After surgery

This refers to the recovery period where you will be immobile for some period of time. You will require help during this time such as help around the house, e.g. cleaning or asking someone to undertake shopping or other tasks for you.

There are a series of mobility aids which can make life that bit easier.

Check with your local social services department to see if you are eligible for any help at home.

Make some adjustments in your home before you have surgery such as ensuring that household items are within easy reach; move cables or loose carpet out of the way and have a ready supply of books or DVD’s to hand. Take time out to rest and allow your surgical wound to heal.

Many of these issues are discussed in more detail in our living with arthritis section.