The destruction of cartilage and joint erosions are a significant concern with rheumatoid arthritis (RA), which may lead to the need for a knee replacement to reduce pain and improve functioning. Knee replacements are not always an easy decision, but the decision is further compounded when you have RA. If having a knee replacement is on the table, there are several factors you need to consider before making your decision on the best possible timing for surgery.
Before you have any planned surgeries, you will need to stop medications you may be taking for RA. This includes corticosteroids, disease-modifying antirheumatics (DMARDs), and biologics. Since these medications are designed to suppress part of your immune system in an attempt to gain control over the disease, they must be temporarily discontinued to reduce your risk of post-operative infection and improve healing. If you have achieved benefits from taking these medications, you will likely experience a significant rebound in symptoms once they are discontinued. It is up to your rheumatologist and orthopedic surgeon to determine when you can restart your medications.
Another concern when stopping medications, specifically DMARDs and biologics, is that they may not have the same effectiveness once you start them again, or they may not work at all. Your decision regarding the timing of your surgery may partly depend on how difficult it was to gain partial or complete control over your RA. If you have spent many years finding the right combination of medications, you may not be ready to take a chance on temporarily stopping treatment.
Post-Operative Impact Of The Disease
RA is a double-edged sword when you consider the damage it can do to the body and how the underlying disease process can increase your risk of post-operative complications. Many variables can affect the outcome of your surgery. This includes having adequate bone growth to secure the replacement joint and the stability of soft tissue structures that support your knee. Ongoing inflammation in your knee can decrease bone density, making your bones more fragile and increasing the time it takes for the bone to fuse around the replacement. Additionally, inflammation weakens many of the ligaments that are responsible for a stable knee joint. Part of your decision to have a joint replacement may rest on the health of supporting knee structures.
Future Knee Repairs Or Replacements
Since RA generally affects joints symmetrically, if the disease has severely affected one knee, you may face a similar need for a replacement in the other knee. Additionally, the extra stress placed on the unaffected (or less affected) knee may accelerate problems. If you are currently on the fence about having a knee replacement or about the timing of the procedure, you should consider the ramifications of waiting too long to have the surgery. Waiting to have surgery until after both knees are significantly affected will make post-operative physical therapy and recovery more difficult.
Other Affected Joints
If you have joints in your upper body that have been significantly affected by RA, you need to discuss with your surgeon how it will affect recovery from a knee replacement. Since you will need upper-body strength and functioning to engage in physical therapy or full use of your hands to use a cane or other assistive device, your concerns may need to be addressed before fixing your knee. Sometimes other surgeries may need to be performed before your knee replacement. For example, you may need to have hand deformities corrected so you can maintain a relatively pain-free grip on a walker or hand railings after your knee replacement.
There is no right or wrong decision when you have RA and need a knee replacement. Considering all aspects of your disease and treatment can help you decide when is the best time to have surgery. For more information and advice, talk to a doctor like Joseph P. Spott, DO.