Arthritis surgery options: from keyhole to joint replacement

Surgery is usually considered when arthritis pain or stiffness is seriously limiting your life and non-surgical treatment has been tried properly. Joint replacement is the most common operation, but fusion, realignment and smaller procedures also have a place. The right choice depends on the joint, your symptoms, your health and what matters most to you.

Written by Louis Maxwell, First Contact Practitioner, HCPC PH128483. Updated 2026-09-25. Pending clinical review.

When is surgery worth considering?

Most people with arthritis never need an operation. Exercise, weight management, pain relief, physiotherapy, aids and, for inflammatory arthritis, disease-modifying medicines help the majority. Surgery comes into the conversation when pain disturbs your sleep most nights, when your walking distance or hand use has shrunk to the point that daily life is hard, or when a joint is visibly changing shape despite good treatment.

X-ray appearance alone does not decide it. Two people with similar X-rays can have very different symptoms. The key questions are how much the joint is affecting your life, what you have already tried, and whether the likely benefits outweigh the risks for you.

Joint replacement

In a joint replacement (arthroplasty), the worn surfaces of the joint are removed and replaced with metal, plastic or ceramic parts. Hip and knee replacements are the most common and, for the right person, can ease pain dramatically and restore walking. Shoulder, elbow, ankle and finger joints can also be replaced, although these operations are done less often and in more specialised centres.

Some people with arthritis in only one part of the knee are suitable for a partial knee replacement, which keeps more of their own joint. Your surgeon will explain which type suits your joint and why.

Joint fusion

Fusion (arthrodesis) joins the bones of a painful joint so that it no longer moves. That sounds drastic, but in joints where a little movement matters less than being pain-free and stable, such as some joints in the ankle, foot, wrist, thumb or fingers, fusion can work very well and last a long time.

The trade-off is lost movement at that joint, which nearby joints partly make up for. Recovery usually involves a period in a cast or boot while the bones knit together.

Realignment, keyhole and other procedures

An osteotomy cuts and realigns a bone to shift weight away from the worn part of a joint. It is sometimes offered to younger, active people with arthritis on one side of the knee, to delay the need for a replacement.

Keyhole surgery (arthroscopy) uses a camera and small instruments. For osteoarthritis of the knee, washing out or tidying the joint is not recommended by NICE as a routine treatment, because it does not help most people more than exercise and other care. It may still be used for specific mechanical problems such as a joint that genuinely locks.

Other operations include removing inflamed joint lining (synovectomy), releasing a trapped nerve, as in carpal tunnel surgery, removing a small wrist bone to relieve thumb-base arthritis (trapeziectomy), and repairing tendons damaged by inflammatory arthritis.

Getting ready for an operation

What you do in the weeks before surgery can make recovery smoother. Strengthening the muscles around the joint, often called prehabilitation, helps you get moving afterwards. Stopping smoking, keeping diabetes and blood pressure well controlled, and treating any skin or dental infections all lower the risk of complications.

Plan your home before you go in: a firm chair of the right height, things you use daily moved to waist height, help with shopping and lifts, and any equipment the occupational therapist recommends. If you take medicines for inflammatory arthritis, ask your rheumatology and surgical teams well ahead whether any need pausing around the operation. Do not stop anything without their advice.

Recovery and risks

Recovery is a process of weeks to months, not days. Most people are helped to get up soon after joint replacement and go home with an exercise plan. Pain, swelling and tiredness are normal early on and gradually settle. Driving, returning to work and getting back to sport each have their own timelines, which your team will guide.

Every operation carries risks, including infection, blood clots, problems with the anaesthetic, nerve or blood vessel injury, ongoing pain, stiffness and, sometimes, the need for further surgery. Your surgeon should talk you through your personal risks, which depend on your health and the procedure.

Seek urgent help for calf pain and swelling, chest pain or sudden breathlessness after surgery.
Contact the ward or your GP promptly about a wound that becomes red, hot, leaking or increasingly painful, or if you develop a fever.

Questions to ask your surgeon

Before you agree to surgery, ask what the operation involves and what it is likely to achieve for you specifically. Ask what the alternatives are, including not having surgery yet, and what would happen if you waited. Ask about your personal risks, the likely recovery time, when you could drive and work, and what help you will need at home. It is reasonable to ask for time to think and, if you are unsure, a second opinion.

Related guides

Last updated 2026-09-25. This is general information, not a substitute for personalised medical advice.

Frequently asked questions

Can I have surgery if I have rheumatoid arthritis?

Yes. People with inflammatory arthritis have joint replacements and other operations regularly. Your surgical and rheumatology teams will plan together, including whether any medicines need pausing around the operation, which should only be done on their advice.

Am I too young or too old for a joint replacement?

There is no fixed age limit. Surgeons weigh your symptoms, general health and activity levels. Younger, very active people may need a further operation later in life, so timing is discussed carefully. Being older is not a reason on its own to rule surgery out.

Will I need to lose weight before surgery?

Some surgical teams ask people to work on their weight first, because it can reduce complications and help recovery. Policies vary around the UK. Ask your GP or surgeon what applies to you and what support is available.

Does keyhole surgery help knee osteoarthritis?

For most people with knee osteoarthritis, keyhole washout or tidying of the joint does not help more than exercise and other non-surgical care, and NICE does not recommend it routinely. It may be used for a specific mechanical problem such as true locking.

What can I do while I wait for my operation?

Keep as active as you can, work on strength around the joint, manage pain with your GP or pharmacist, and prepare your home. Tell your GP if things get significantly worse while you wait, as your priority may need reviewing.

How long does a joint replacement last?

Modern hip and knee replacements usually last many years, and most people will not need another operation on the same joint. How long yours lasts depends on factors including your age, activity level and the type of implant. Your surgeon can talk through what to expect.