Massage Therapy Journal Summer 2026

48 • Massage Therapy Journal

AMTA Continuing Education

Minimally invasive TJR replaces a damaged joint using shorter incisions than in a traditional TJR. Less muscle is cut and reattached. Thomas Sculco, MD, surgeon-in-chief emeritus at Hospital for Special Surgery in New York City, says “minimally invasive” is something of a misnomer, though, because the procedure “still involves cutting bone, realigning the soft-tissue mechanism that supports the joint and placing the implant.” There may be less pain, less time in the hospital and quicker recovery than with conventional joint replacement, but minimally invasive TJR has a higher complication rate than traditional TJR. 63 All artificial joints can wear out eventually, however, which may require joint revision surgery, and can be more expensive and less successful than the original surgery. Implants made entirely of metal, called metal-on-metal implants, can release metal ions that may damage bone and cause other health problems. TJR is not usually recommended for people who have weak bones or who are obese. 64 Joint revision removes a failed, infected or worn-out implant and replaces it with a new one to provide pain relief and improved mobility, strength and coordination. Because of the alterations surgeons make to bones during an original joint replacement, however, revision procedures are more complex and less successful than initial replacement surgeries. Complete pain relief and return to full function may not be possible. Sometimes surgeons need to take a bone graft from another area to complete the operation. Possible complications include a higher fracture risk after surgery, and in the hip, dislocation and uneven leg lengths. 64 Surgical Complications for Joint Replacement Surgeries Any surgery is a challenge when the patient has RA, requiring preoperative adjustments and presenting varying postoperative risks. Complications of joint replacement surgery are more likely for people who have RA. The most common complications include: 65

• Infection. Infection can occur at the incision site or in deeper tissue, near the new prosthetic implant. If the infection affects the prosthesis, a subsequent replacement surgery may be necessary. Infection risk may be lowered by making changes to certain RA medications, such as biologics and corticosteroids, stopping or lowering dosages for about a week before and after the planned procedure. • Dislocation. As the new joint begins to heal, it may pop out of the socket when in certain positions. Wearing a protective brace can help prevent dislocation during the healing process; repeated dislocations, however, can mean additional surgery. • Mechanical failure. Wear and tear, loosening or breakage of the prosthesis is possible. In an RA patient, the overactive immune system may attack the bone around the prosthetic implant, which could cause it to come loose or break off. • Blood clots. Postsurgical clots can form in lower extremities following knee or hip surgery, break off and cause serious injury in the lungs, heart or brain. Upright movement as soon as possible following surgery, wearing compression stockings or inflatable sleeves, and taking anticoagulant drugs short-term can help to increase circulation and prevent clot formation. • Leg length discrepancy. Following hip replacement, tight muscles surrounding the hip can cause the limb on the surgical side to shorten; this unequal leg length can be remediated with careful stretching, when healing has become established and dislocation is less likely. Supplemental Therapies for RA Patients In addition to medications and medical and surgical procedures, people with RA utilize supplementary therapies—non-pharmaceutical and nonsurgical—to help manage symptoms, disease progression, and the effects of RA on the individual and family members.

Complications of joint replacement surgery are more likely for people who have RA.

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