I’ve had three joint replacements – hip, shoulder, and knee (in order of replacement) so I’m somewhat of a poster child for the procedures. However, until I read a recent article in U.S. News and World Report I really hadn’t thought about the fact that there might be different considerations for people with joints damaged by RA as opposed to those who suffer from osteoarthritis (OA) – or simple wear and tear of the joints. I mean, regardless of the cause, if a joint is severely damaged enough, a replacement is a logical consideration, right?
Joint replacement in RA vs. OA
It turns out that historically, they thought that people with RA wouldn’t have as successful outcomes as those people with OA, but studies have disproved that notion. The results are very comparable.
One thing I found really interesting is that with earlier and better treatment of RA, there are fewer RA patients needing joint replacements than in years past. It is thought that controlling the disease helps prevent joint destruction and the resulting surgery.
Some factors to consider
This is great news. But like the other parts of our lives, RA tends to complicate joint replacement surgery. For example, the drugs we take can lower the immune system which can increase the chance for infection – so we need to go off the drugs for a period before and after joint replacement. This can often lead to a flare during the recovery period. Many people with RA also have other issues (or comorbidities) that can complicate surgical procedures and recuperation. These include not only physical issues but things like depression. And there are other complications I hadn’t even considered – like RA in your neck can make it difficult to insert a breathing tube.
Many things are the same, however. Especially important is the person’s condition before the surgery. A person who is still mobile – even walking with a cane – will generally have a better result with knee or hip replacement surgery than someone who has been wheelchair bound for a long time and lost significant muscle mass.
Joint replacement is a really big surgery and, I’ll admit, it can be scary. But I’m always interested when I meet someone who is afraid to get joint replacement because things will get worse. I won’t say that’s never happened, but my joint replacements have been life changing for the good. I’ve gone from intense, constant pain and limited mobility to living a busy productive life.
When is it time to consider joint replacement?
For a person with RA, that answer can be a bit more complicated than someone with OA. X-rays are a pretty good indicator of joint damage. If an RA patient is reporting more pain than an X-ray might indicate should be happening, then it may be that the RA treatment isn’t effective and needs to be adjusted – rather than the joint needs to be replaced.
But there are times when a joint replacement discussion is appropriate. I’ve had it happen both ways. With my hip, I started the conversation. With my shoulder, my doctor told me there wasn’t any other option. For my knee, it was sort of mutual agreement. My doctor and I had run out of more conservative options like steroid and hyaluronic acid injections and physical therapy. I had the privilege of interviewing my orthopedic surgeon on the topic and that discussion can be found here.
So while the bad news is that RA can damage your joints and that has the potential to cause you to need to have replacement surgery, the good news is that patients with RA can expect to have positive outcomes.