Psoriatic arthritis (PsA) surgery aims to relieve pain, restore mobility, and improve the quality of life for individuals with advanced PsA. There are various surgical treatment options available.

Psoriatic arthritis (PsA) is a chronic inflammatory condition that affects both the skin and joints, causing pain, swelling, and stiffness. While treatment options can include medications, lifestyle changes, and physical therapy, some people require surgical intervention to address severe joint damage.

This article discusses the types of surgery for PsA, when surgery may be necessary, eligibility criteria, and potential risks, and it provides details about the procedure.

A physical therapist applying blue tape to a man's back as part of rehabilitation after psoriatic arthritis surgery.Share on Pinterest
Svitlana Hulko/Getty Images

There are various surgical options for psoriatic arthritis (PsA), depending on an individual’s specific needs, the severity of their condition, and the joints it affects.

The most common type of surgery for PsA is arthroplasty, or joint replacement. It involves replacing a joint with an artificial implant made of metal, ceramic, or plastic. The procedure aims to reduce pain, improve mobility, and restore joint function.

Other types of surgery for PsA include:

  • Synovectomy: This is the removal of inflamed synovial membrane that lines the joints. Removing this tissue may decrease pain and swelling. Surgeons can perform this procedure through open surgery or minimally invasive techniques.
  • Joint fusion (arthrodesis): This involves fusing bones in a joint together to prevent movement, stabilize the joint, and reduce pain. It can be an option when joint replacement is not possible. This surgery is typically for smaller joints, such as those in the hands, feet, or spine.
  • Tendon repair: This involves reattaching or reconstructing damaged tendons to restore function and strength.
  • Osteotomy: This involves cutting and realigning bones to correct misalignment and relieve pressure on the affected joint.
  • Resection: This is the removal of part or all of a bone or an entire joint, often to treat damaged joints in the foot and big toe.

A doctor may recommend surgery for cases of PsA where there is severe damage to a joint or when other treatment options are not effective. Several factors can indicate that surgery might be necessary, such as:

  • severe joint pain at rest or when walking that is unresponsive to nonsurgical treatments, such as medication or physical therapy
  • loss of joint function that impairs movement or daily activities
  • visible deformity of the joint that limits mobility or causes significant discomfort

An early diagnosis and appropriate treatment can slow down the progression of PsA. Treatment may also help reduce or prevent permanent damage to the joints.

Not everyone with PsA can undergo surgery. Whether someone is a good candidate depends on several factors, such as:

  • the severity of the joint damage
  • overall health
  • willingness to participate in joint rehabilitation after surgery

Factors that may make a person ineligible include:

  • Infection: Active infections in the body or at the surgical site can delay or prevent surgery.
  • Plaque psoriasis: Experts do not recommend operating on areas where there are psoriasis plaques. If plaques are affecting the skin around the joint, a person may need to undergo treatment for this first.
  • Impaired wound healing: Psoriasis can affect how the skin heals. Some medications for PsA, such as biologics, may also affect wound healing. If a person has a history of poor wound healing, doctors may take this into account when considering surgery. In some cases, people may need to adjust their medication in order to undergo surgery.
  • High risk of complications: People with severe heart or lung conditions, untreated diabetes, or other serious health issues may generally be at higher risk of complications in any type of surgery.

As with other surgeries, PsA surgery has some risks, such as:

  • infection
  • poor wound healing
  • hematoma, which is a collection of blood under the skin
  • nerve damage
  • blood clots
  • reaction to anesthesia
  • implant failure or wear, for those having a joint replacement

Surgery also has some specific risks for those with PsA and psoriasis. For example, some find that surgery causes a flare-up. This can be temporary but may be uncomfortable or painful.

If a person has to change their usual medications, they may also experience more symptoms in the run-up to the surgery and while they are healing. However, the long-term results of surgery may outweigh this possibility.

The specifics of PsA surgery will vary depending on the type of procedure. However, the procedure for joint replacement, which is the most common surgery for PsA, is as follows.

Preparation

Before surgery, a person will undergo a series of evaluations, including blood tests, imaging studies, and a review of their medical history, to make sure they are a good candidate for the procedure.

The surgical team will then explain what the surgery involves, the potential risks, and postoperative care that will be necessary.

If a person agrees to the procedure, they will also provide instructions for preparing for the surgery, such as medication adjustments.

Surgery

On the day of the surgery, a healthcare professional will administer a regional or general anesthetic via injection.

General anesthesia puts people to sleep during the procedure, whereas regional anesthesia numbs a specific part of the body to prevent pain.

Next:

  1. A healthcare professional will clean the skin around the joint.
  2. A surgeon will make an incision near the joint so they can access the interior.
  3. They will remove damaged cartilage and bone.
  4. With the damaged parts gone, the surgeon will then fit the new prosthetic joint.
  5. The surgeon will close the incision, and a healthcare professional will apply a clean dressing to cover it.

The duration of a joint replacement procedure can vary, ranging from 1 to several hours.

After surgery to replace a joint, healthcare professionals will move a person to a recovery room. They will monitor the person while the anesthetic wears off, looking for any signs of complications and helping them manage pain with medications.

People may spend several days in the hospital following surgery before going home. They may need someone else to drive them home and help them with daily tasks for a while.

Around 10 days later, people may need to return to the hospital for stitch removal. Doctors may recommend a follow-up appointment around 6 weeks after the procedure to see how the area is healing and the results.

Complete recovery from PsA surgery can range from several months to a year. People may experience temporary pain as the body recovers from the procedure and the tissues heal.

Doctors or physical therapists will provide specific exercises to restore movement and strengthen the joint. Physical therapy is an important component of recovery, helping to restore strength, flexibility, and function.

Psoriatic arthritis (PsA) surgery can be a viable option for individuals with severe joint damage and pain that no longer respond to nonsurgical treatments. The surgery may involve removing inflamed tissue or bone, joint replacement, or joint fusion, depending on the situation.

While surgery carries risks, the potential benefits, such as reduced pain and improved function, can be significant for some. Doctors will carefully consider whether surgery is a promising treatment for each person based on their unique circumstances and which procedure would be most helpful.

Recovery from PsA surgery can take some time and typically requires physical rehabilitation.