Psoriatic arthritis surgery: Types, benefits, risks

If your joints feel like they've been replaced by rusty hingesdespite the meds, injections, braces, and all the "good patient" thingsyou're not alone. When psoriatic arthritis steals movement or keeps you up at night, psoriatic arthritis surgery can be a turning point. It's not a magic wand, but it can be a powerful reset. Let's walk through what it involves, who it's for, and how to decidetogether with your care teamif now is the time.

I've sat with folks who were terrified of surgery and others who said, "I wish I'd done this years earlier." Both feelings are valid. This guide keeps it honest about the benefits and the risks, so you can make the call that fits your body, your life, and your goals.

When surgery helps

Signs it may be time

How do you know when psoriatic arthritis surgery is on the table? Your care team usually looks for a few red flags that say, "Conservative care has done its best." These include persistent severe pain that doesn't budge with medication, clear joint damage on X-ray or MRI, loss of function (like struggling with stairs or opening jars), visible deformity, or a tendon rupture. If everyday tasks feel like a battleeven on your strongest daysthat's a clue the joint may need mechanical help.

Red flags your team watches

There are patterns clinicians watch for: ongoing inflammation that keeps eating at cartilage and bone, joints drifting out of alignment, or tendons fraying from chronic enthesitis (inflammation where tendons attach to bone). If you've already tried disease-modifying meds (DMARDs), biologics, injections, physical therapy, and braceswith limited reliefsurgical procedures for arthritis may become part of the psoriatic arthritis treatment plan.

After trying other options

Most surgeons want to see that you've pushed conservative care as far as reasonable: DMARDs and biologics to calm systemic inflammation; steroid or hyaluronic injections to quiet flares; targeted PT and OT; splints, braces, shoe inserts; weight management; and activity modification. If those tools don't restore function or stifle pain, surgery may be the next right step.

Joints most often treated

Psoriatic arthritis doesn't play favorites, but some joints show up to surgery more often: hands and wrists (for synovectomy, tendon repair, or fusion), knees and hips (for joint replacement surgery), ankles and feet (for fusion or deformity correction), shoulders and elbows (for repair or replacement), and sometimes the spine in specific cases.

Common targets

Hands/wrists, knees, hips, ankles/feet, spine, shoulders, elbowseach with its own menu of arthritis surgery options depending on your anatomy, symptoms, and goals.

Who isn't a great candidate?

Safety first. Active skin infection, especially near the incision site, uncontrolled psoriasis plaques over the surgical area, or serious medical conditions that raise anesthesia or healing risks might pause the plan. Smoking greatly increases wound and bone-healing complications. It doesn't mean "never," but it does mean "not yet"with time to optimize skin health and overall risk before moving forward.

Surgery types

Synovectomy

Picture the joint lining (synovium) like a too-thick sweater that's inflamed and bunching. A synovectomy removes that inflamed lining. It can be done arthroscopically (small incisions with a camera) or open (larger incision), depending on the joint and extent of disease.

Best uses and approach

Best for localized synovitis that hasn't responded to meds, often in the wrist, knee, or fingers. Arthroscopy usually means smaller scars and quicker initial recovery; open surgery may be needed for extensive disease or small, complex joints.

Benefits, recovery, recurrence

Benefits include pain relief, less swelling, and improved motion. Recovery might be a few weeks to a few months depending on the joint and technique. Recurrence can happen because PsA is systemicso keeping your rheumatologic treatment optimized after surgery is key.

Tendon and ligament repair

Enthesitis can weaken the structures that move and stabilize your joints. Sometimes tendons partially tear or fully rupture. When that happens, repair or reconstruction can restore function.

Triggers and what happens

Typical triggers include a tendon rupture in the finger or ankle, or progressive damage from chronic inflammation. During surgery, the surgeon reattaches or reconstructs the tendon/ligament, sometimes using grafts. Expect a period of immobilization to protect the repair, followed by physical or hand therapy to regain motion and strength.

Rehab timeline

Plan on several weeks in a splint or boot, then guided rehab over 816 weeks. The exact timeline depends on the tendon, the quality of tissue, and your healing response.

Joint fusion (arthrodesis)

When a small, painful joint is too damaged to move smoothly, fusion can be a relief. The surgeon removes the damaged cartilage and stabilizes the bones so they grow together. No motion at that jointyesbut often huge pain relief and better stability.

When fusion is best

Fusion is often chosen for small joints like the ankle, wrist, or certain finger joints where stability matters more than motion. It's steady, reliable pain control. The trade-off is losing movement at that joint, which your body often compensates for with neighboring joints.

Pain relief vs motion

Most people choose fusion when they're saying, "I'll take stable and pain-free over painful and wobbly." For active folks with severe ankle arthritis, for example, fusion can mean walking farther without the sharp, grinding pain.

Joint replacement (arthroplasty)

Think of it as renovating a joint rather than demolishing it. The damaged surfaces are removed and replaced with metal, plastic, or ceramic components designed to glide. Hips and knees are the superstars here, but shouldersand sometimes small jointscan be replaced too.

Implants, longevity, revision

Modern implants are durable, with many lasting 1520 years or more. But they aren't forever. Younger, more active patients may outlive an implant and need a revision later. Good positioning, healthy bone, and steady rehab help protect your new joint.

Debridement and osteotomy

Debridement smooths bone spurs and removes loose bits that irritate the joint. Osteotomy re-aligns a bone to shift load away from a damaged area. These are targeted fixessometimes used to buy time before a replacement or to improve mechanics for better function.

Foot and hand specifics

Feet and hands take a beating in PsA. In the forefoot, a big-toe MTP fusion can straighten the toe and relieve pain. Hammertoe correction can make shoes tolerable again. In the wrist, partial versus total fusion balances pain relief with preserving some motion. Hand surgeons tailor the procedure to your functionpinch, grip, dexterityand your daily life.

Why it's worth it

Pain and function

Let's be realistic and hopeful. Many people report significant pain reduction after surgery, often moving from constant sharp pain to intermittent soreness that's manageable. What does that translate to? Walking a mile without stopping. Climbing stairs without gripping the railing in fear. Getting your hand around a mug without wincing. For some, it's sleeping through the night for the first time in ages.

Real-life goals

Your goals might be simple or ambitious: carry a toddler, garden for an hour, go back to work without accommodations, or return to light jogging. Surgery can reset what's possible.

Correcting deformity

When joints drift or collapse, shoes don't fit, tools feel awkward, and independence slips. Correcting deformity can open your world againmore footwear options, better balance, less strain on neighboring joints. And yes, better sleep and more energy at work often follow.

Quality of life

When pain shrinks, your world expands. People often describe feeling more like themselvesmore social, more active, more patient with loved ones. Recovery takes work, but the mental lift from moving without constant pain is real. Depending on the procedure, some folks return to gentle sports, hiking, or yoga with modifications. Your team will guide what's safe and when.

Know the risks

General surgical risks

Every surgery has baseline risks: infection, blood clots, anesthesia issues, wound healing problems. Because skin in PsA can be fragile, active plaques near the incision raise infection risk, so surgeons and dermatologists often coordinate to calm the skin first.

PsA-specific notes

Medication timing matters. You and your rheumatologist will create a plan for managing biologics and DMARDs around surgery to reduce infection risk while preventing flares. Have a flare planwhat to do if symptoms spike during recoveryso you're not scrambling.

Procedure-specific risks

Fusion can rarely fail to unite (called nonunion), especially with smoking or poor bone quality. Joint replacements can loosen or wear over years, sometimes needing revision. Stiffness, nerve irritation, or persistent pain can happen with any procedure, though careful rehab and good surgical technique reduce the odds.

How to lower your risk

Optimize what you can control: get skin as calm as possible pre-op; stop smoking if you can (even a few weeks helps); keep blood sugar in range if you have diabetes; ask about nasal decolonization or antiseptic washes; and do "prehab" to strengthen the muscles around the joint. These steps sound small but add up to better outcomes.

Surgery or not?

Compare your options

Not every joint needs a scalpel. MedicationsDMARDs, biologics, JAK inhibitorsaddress the root inflammation. Injections can quiet a flare. Splints, PT, orthotics, and weight management offload stress and support function. But what these can't do is reverse structural damage already present on imaging. Surgery steps in when mechanics, not just inflammation, are the main culprit.

Shared decision checklist

Ask your surgeon and rheumatologist: What are realistic outcomes for my joint? How will this affect function I care about (stairs, grip, balance)? What is the recovery timeline week by week? What are my alternatives? How many of these procedures do you perform a year? What are your infection and revision rates? How will we manage my biologic/DMARDs before and after surgery?

Second opinions and centers

High-volume centers usually have tighter protocols and stronger outcomes data. Don't hesitate to see a board-certified specialist in hands, feet, hips, or knees for targeted surgeries. A confident surgeon welcomes your questions and a second opinion.

Prep smart

Pre-op workup

Expect imaging, labs, and infection screening. A dental check may be advised before joint replacement to reduce infection risk. Your skin will get special attentionany plaques near the incision need calming first.

Medication plan

Some meds are paused pre-op and restarted after the wound seals; others continue. Your team will guide timing for biologics/DMARDs, steroids, NSAIDs, and blood thinners. Write the plan down and keep it visible.

Home and life setup

Line up mobility aids (cane, walker, shower chair), wound care supplies, rides to appointments, work leave, and a caregiver plan for the first week or two. Rearrange living spaces to avoid stairs if possible. Think of it like setting the stage for a smooth recovery.

Surgery day

You'll likely fast after midnight, use an antiseptic wash, and review the operative site and pain control plan with your team. Nerves are normal. Breathe. You've prepared for this.

Heal and rebuild

Typical timelines

Synovectomy: often quicker recovery, with early motion guided by therapy and gradual return to activities in weeks to a few months.

Tendon repair: protection first (splint/boot), then staged rehab over 24 months.

Fusion: non-weightbearing or protected weightbearing for several weeks until X-rays show bone healing; full recovery can take 36 months, sometimes longer for ankles.

Joint replacement: standing and walking often start day one or two; meaningful gains in 612 weeks; full strength and confidence build over 612 months.

PT and OT

Rehab is the secret sauce. Early on, it's swelling control, gentle motion, and scar care. Then strength and movement patterns. Hand therapy is its own arttiny exercises, big payoffs. Be consistent; future-you will be grateful.

Pain management

Most teams use multimodal pain control: acetaminophen, anti-inflammatories if safe, nerve blocks, and short-term opioids if needed. Ice, elevation, and pacing are underrated superheroes. If opioids are prescribed, have a taper plan from day one.

When to call

Call your team for fever, increasing redness or drainage, a rash near the incision, severe swelling or pain that isn't controlled, calf pain or sudden shortness of breath, or anything that just feels "off." You know your bodytrust that intuition.

Back to life

Desk work often resumes in 26 weeks depending on the surgery and your commute. Manual jobs take longer. Driving returns when you're off opioids and can brake safely. Sports and hobbies come back in phasesask your surgeon for a personalized timeline so you can circle milestones on the calendar.

Costs and logistics

What affects cost

Procedure complexity, hospital vs ambulatory center, implant type, anesthesia, and post-op PT visits all influence cost. Surgeons' offices can help estimate your out-of-pocket range based on your insurance.

Insurance basics

Prior authorization is common. Documentation of failed conservative care (meds, injections, PT) speeds approval. Keep a folder with notes, dates, and provider namesit's surprisingly helpful.

Financial help

Ask about hospital financial assistance, payment plans, and community resources. Some implant manufacturers and foundations offer support programs. Social workers can be fantastic guides here.

Real stories

Snapshots from patients

"My wrist synovectomy gave me back my keyboard." After months of painful swelling despite methotrexate and a biologic, a minimally invasive synovectomy calmed things down. Within six weeks, typing didn't feel like sandpaper anymore.

"Ankle fusion made me steady again." A runner-turned-hiker chose fusion after years of sprains and grinding pain. She misses ankle flex, surebut she's back to 5-mile trails without the sharp, breath-catching jolts.

"Total knee replacement changed my mornings." After failed injections and braces, he chose joint replacement surgery. The first month was hard work. At three months, stairs felt doable. At a year, he said simply, "I got my life back."

Tips from the trenches

Shower stools and long-handled sponges are worth their weight in gold. Loose, soft clothing you can pull on one-handed? Yes, please. Sleeping with pillows supporting the limb eases night aches. And if a flare pops up during rehab, tell your therapistthere's always a way to adapt without losing momentum.

Evidence and guidance

What research shows

Studies generally show meaningful pain reduction and functional gains after appropriately selected procedures in PsA, with infection risks slightly higher than osteoarthritis when skin disease is activeone more reason pre-op skin optimization matters. Implant survival for hips and knees in PsA is often comparable to osteoarthritis when inflammation is well-controlled.

Guideline highlights

Rheumatology and orthopedic guidance positions surgery as part of comprehensive psoriatic arthritis treatment when structural damage limits function or pain persists despite optimized medical therapy. Coordinated care across specialties improves outcomes. According to consensus documents from professional societies like the American College of Rheumatology and the American Academy of Orthopaedic Surgeons, timing and medication management are key to balancing infection risk with flare prevention. For deeper reading, see this overview of arthritis care models in a peer-reviewed resource according to clinical reviews.

Where we need more data

We still need stronger research on small-joint procedures, optimal biologic timing around surgery, and long-term implant survival specifically in PsA. The good news: more registries and patient-reported outcome studies are underway.

Choose your team

Credentials matter

Look for board certification, fellowship training in the relevant area (hand, foot/ankle, adult reconstruction), and surgeons who can share their procedure volumes and outcomes. A surgeon who listens, explains trade-offs, and treats you like a partner is priceless.

Coordinated care

Your dream team: surgeon + rheumatologist + dermatologist. When they align on skin optimization, medication timing, and flare prevention, you get safer surgery and smoother recovery. Ask how they coordinatesome centers run joint clinics or shared protocols.

So, where does this leave you? If your days are shaped by pain, if function is slipping even with strong medical therapy, psoriatic arthritis surgery may help you move with more ease and confidence. The decision isn't simplebut it is yours.

What matters most to you right nowless pain, more strength, better balance, playing with your kids, returning to work? Write those down and bring them to your next visit. Ask the tough questions. Seek a second opinion if you want. You deserve clarity and a plan that feels right in your bones.

And if you've had surgery, what helped you the most during recoveryan honest friend, a great therapist, or the right pillow? Share your experience. Your story might be the nudge someone else needs.

Psoriatic arthritis surgery isn't a shortcutit's a thoughtful step on a longer path. With the right procedure, careful prep, and a team that truly sees you, that path can lead back to movement, joy, and the life you've been missing.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.