Arthritis

Surgery

As drug treatments are continually improving, many young people with arthritis will never need to have surgery. Most young people can effectively manage their condition through their medication and lifestyle. Therefore the decision to have surgery is usually only made after other treatment options have been explored. You should find out as much as you can about the different surgical procedures before weighing up the pros and cons with your doctor.
 
Reasons for needing surgery
We spoke to some young people with arthritis who had surgery. Some needed surgery on parts of the body affected by arthritis. Others had keyhole surgery (surgery using a small tube with a camera) so doctors could look inside the body and get a better idea of the condition of their joints. Sometimes people needed surgery because taking steroid medication over a long period of time had caused their joints to become weak and crumbly. People also talked about having artificial joints replaced in the future (for example, most modern hip replacements have a 'shelf life' of about 20 years). Some young people talked about eye surgery because of JIA-associated eye disease, such as chronic anterior uveitis.
 
X-rays were sometimes used to see if an operation was needed. People who saw their x-rays described their bones as looking “jagged”, “worn away”, covered in “little tiny holes” or having pieces “missing” from certain areas. People could compare and contrast old x-rays to new ones and see how their bones had changed over time. Some were shocked when they saw how badly their joints were damaged. Others were surprised to learn that taking steroid tablets could cause bone damage.
Postponing surgery 
Doctors sometimes waited before they operated. Elizabeth’s doctor did not perform surgery on her eye until her arthritis settled down. Jessica’s doctor did not want to replace her hip before her eighteenth birthday. David Y was told he could not have an operation to fix his broken leg because he could get an infection and lose the leg.
 
Sometimes people decided to wait a while before surgery. Dean was not sure if he wanted his jaw replaced because it would only last four years. This type of surgery is very rare. Dan did not want operations on his fingers and legs to stretch them out because he could still use them. Cat had her hip replacement during Christmas holiday so she did not miss university (see ‘Choosing and refusing treatment).
 
Knee, hip and shoulder replacements
People who had hip replacement surgery were very positive and said that it made a big difference. They experienced less pain and had more mobility with the new hip. Jessica had her hip replaced the day after her eighteenth birthday. She said it was “the best birthday present”. When she had the other hip replaced she also needed to have healthy bone taken from one part of her body and put near her hip (bone graft). She was not allowed to bear weight on her leg for six weeks afterwards.
Surgery to ease or prevent symptoms
Some of the people we spoke to had shoulder surgery. This involved placing a metal cap between the shoulder blade and the shoulder ball which stopped them grinding against each other. Jessica needed some of her shoulder bone shaved before she had the cap put on. She wore an arm sling for six weeks after the operation and she was given exercises to do which she said “definitely helps”. Ruth was in hospital for ten days then had exercises to do at home.
 
Sometimes pain in a joint can be eased by having the bones fused together. Some of the people we spoke to had bones in their wrists or ankles fused together so that they can no longer move.
Catherine had knee synovectomies. This involved having some of the tissue in her knees removed so her knees swelled less during a flare up. She was allowed home the day after surgery but she was off work for 4 weeks after each operation. People with inflammatory arthritis (such as JIA) rarely have this type of surgery and nowadays doctors use steroid injections instead.
Pain management during surgery
Sometimes people were asleep (anesthetised) during the operation. Ruth was awake during her operation but felt no pain because she had a regional painkiller (epidural) meaning that it numbs one part of your body. She said that “the most horrific thing” was not the operation but the thought of being looked after on a strange ward by nurses she did not know. She was also worried about her period starting when she was being operated on.
Keyhole surgery (laparoscopy)
Doctors sometimes conducted keyhole surgery to take a closer look at people’s joints. Keyhole surgery involves a doctor making tiny cuts and putting a camera in the part of the body to get a better look.
When surgery doesn't help
Not everyone who had an operation said they benefited in the long run. Dan said his doctor cut his tendons and stretched his muscles to make his hip flexible. This helped for a short while but then his hip got worse. Melissa had hip problems too. She had the muscle in her hip cut (soft tissue release) but this did not make her more flexible. She was in hospital for eight weeks after the operation. Ruth’s bones were so soft that her doctor broke her leg when replacing her hip. She needed to have the broken bone pinned together during the operation.
 
Due to major advancements in arthritis treatment over the last 10 years it’s very rare for young people to need all of these operations. You can read more about different types of surgery at Arthritis Research UK. Please keep in mind that the information is written for adults. Young people rarely require surgery nowadays because of improved treatments.

Last reviewed August 2015.

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