Massage Therapy Journal Summer 2026

Summer 2026 • 47

joint. In the knee, an osteotomy shifts weight from an area damaged by arthritis to an undamaged area. In the hip, it is often used to correct misalignment (hip dysplasia) that occurs early in life. A successful osteotomy can halt damage and delay the need for a joint replacement for 10 to 15 years. 60 Synovectomy. In people with inflammatory arthritis such as RA, the synovium is inflamed and can become enlarged, damaging surrounding cartilage and joints. In this procedure, surgeons remove most or all of the affected synovium, either in a traditional, open surgery or by using an arthroscope. A synovectomy may temporarily relieve pain and improve function, and people who have undergone the procedure may be able to reduce their use of anti-inflammatory drugs. 60 Arthrodesis (fusion). Surgeons use pins, plates, rods or other hardware to join two or more bones in an ankle, wrist, thumb, finger or the spine, making one continuous joint. Over time, the bones grow together and lock the joint in place. Ideally, fusion results last a lifetime, though revisions are often needed. People who have weight-bearing joints fused can often safely take part in high-impact physical activities. Fusing joints, however, reduces their motion and flexibility, altering the joint’s normal biomechanics, which can put stress on surrounding joints and often leads to arthritis in other areas, as well as chronic pain. Physical therapy and exercise may be more effective, with no serious complications. 60 Total joint replacement (TJR) or total joint arthroplasty replaces a damaged joint with a prosthetic implant that mimics the motion of the natural joint. Implants are made from combinations of metal, plastic and/or ceramic components. TJR has a proven track record for safety and success, reducing pain and improving mobility, daily functioning and quality of life. 60 The joints most often replaced for people with moderate-to-severe RA include the hip, knee and shoulder. Hip and knee replacement. The use of DMARDs has reduced the need for both total

Surgical Procedures for Patients with RA

Arthroscopy

Joint resurfacing

Osteotomy

Synovectomy

Arthrodesis (fusion)

Total joint arthroplasty

Replacement surgeries

Joint revision

knee and hip arthroplasties in patients with RA. Since 1991, the proportion of patients with RA who undergo total knee arthroplasty has dropped from 21 percent to as low as 2.4 percent. However, there is still a far greater long-term risk of undergoing both procedures in patients with RA when compared with patients who do not have RA, according to a study published in The Journal of Arthroplasty . 61 Total hip replacement is an effective option for people with moderate to severe RA who have severe hip pain and limited mobility, and when medication and less invasive treatment methods no longer manage pain. Factors such as age, overall health, and the condition of the hip itself— whether or not osteoporosis damage has rendered the femur ineligible for the procedure—are weighed when considering this surgery. 62 Knee replacement surgery is considered when severe knee pain and continued destruction of the knee are not helped by RA medications. 62 Shoulder replacement. RA often leads to rotator cuff dysfunction. Severe rotator cuff thinning caused by inflammation in both the glenohumeral joint and subacromial bursa is common in RA patients. Rotator cuff involvement may occur in as high as 75 percent of RA patients. 62

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