Doctors rarely turn to surgery for gout. People who have this painful form of arthritis take non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to deal with agonizing gout attacks. Otherwise, doctors urge gout patients to eat a balanced diet, exercise, and lose weight as the best means of treatment.
"With my patients, I'm always trying to give them lists of the good foods that prevent gout and the bad foods that promote gout," says Edward McDevitt, MD, a partner and orthopedic surgeon with Bay Area Orthopaedics in Annapolis, Md. "Most of the time, people with gout can be treated without surgery."
Surgery for Gout: When Tophi Form
However, there are circumstances under which surgery for gout should be considered. Surgery most often is used to remove gritty, chalklike nodules called tophi — a single one is called a tophus — that form in a person's joints as a result of gout. These nodules can be uncomfortable and unsightly, and in rare instances cause dangerous infections.
Gout occurs when too much uric acid builds up in the bloodstream. Crystals formed of uric acid begin to build up in the body's tissues and joints. Those crystals begin wearing away at the cartilage in the joints, causing painful arthritis.
In chronic cases of gout, uric acid crystals may begin to form tophi in cooler areas of the body such as the elbows, knees, forearms, hands, feet, and curved ridge of the outer ear.
Most of the time, these tophi are harmless and can be shrunk using medications. "It's not usually too painful," Dr. McDevitt says. "It's more of an annoyance."
Surgery for Gout: When the Tophi Must Go
There are times when surgery for gout to have the tophi removed is necessary:
- Sometimes the tophi can interfere with the mechanical action of a joint, preventing you from having a full range of motion. "If it's a mechanical block, sometimes you can't really use the knee or elbow or toe in a way you'd like to," McDevitt says.
- You may decide that the tophi have become unsightly and will elect surgery to have them removed for cosmetic reasons.
- In rare cases, larger tophi can become infected and require surgical removal.
"It just depends on how big they are and how they affect the joint," McDevitt says, explaining that he most commonly removes tophi from a patient's elbow. "When people rest their arm on a table, there's a bump there that can be awkward and uncomfortable. It also can interfere with how the elbow bends."
Surgery for gout to remove tophi is not complex or difficult. "Usually it means making an incision just over the tophus," McDevitt says. "Then you dissect and remove it. It's a pretty simple procedure."
Joint replacement surgery for gout may be needed due to the damage done by uric acid crystals. "Erosion caused by the little crystals can destroy the cartilage to the point that joint replacement is required, but that's very unusual,” says McDevitt. “We always try to get it treated so we don't get to that point.”