Surgery may help reduce pain and other symptoms of severe gout. The three main types of surgery for more advanced gout include tophi removal, joint fusion, and joint replacement.

Gout is a chronic, inflammatory form of arthritis. A person may experience painful flares, along with periods of remission.

Although gout often starts in the big toe, symptoms can occur in almost any joint. Individuals can control symptoms and prevent new flares using a combination of medications and lifestyle changes.

In some cases, gout can damage the joints or cause unrelenting pain. If this occurs, a person may require surgery to help relieve symptoms or restore movement to the joint.

In this article, we look at surgical treatment options for gout, recovery, and aftercare.

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People can often control gout symptoms with medications and lifestyle changes. For some people, symptoms may only occur once every few years.

Others may experience more frequent chronic flares. When this occurs, it is known as chronic tophaceous gout. This more advanced form of gout causes the formation of uric acid tophi, which are hard deposits that can form under the skin, leading to cartilage and bone damage.

A doctor may recommend surgery in extreme cases if the tophi:

  • become infected
  • cause major joint shape changes
  • result in severe pain
  • compress crucial nerves

There are currently three surgical options for people with more advanced cases of gout.

Tophi or crystal removal

Tophi removal involves the removal of the painful, infected, or swollen growths. The procedure consists of cutting a tophus out while keeping as much of the surrounding tissue intact as possible.

According to Creaky Joints, a doctor may decide on this option if the tophus is infected or causing severe pain or changes in joint shape.

Doctors may also remove uric crystals if these are causing severe pain.

Joint fusion

Joint fusion involves fusing the bones in a joint together. This surgery may cause a person to lose some mobility, but it should provide some relief from symptoms such as chronic pain. Surgeons often use joint fusion on smaller joints, as it can help reduce pain.

Joint replacement

In some cases, a doctor may recommend joint replacement. In this procedure, doctors remove the damaged, painful joint and replace it with an artificial joint. This procedure can help reduce pain and improve mobility.

The most common location for this surgery is the knee.

Doctors will base their decision on whether to perform surgery on the severity of a person’s symptoms.

Symptoms that may warrant surgery include:

  • chronic pain that does not go away
  • severely damaged joints that limit mobility, such as damage to the knee
  • infected tophi
  • leaking tophi
  • symptoms that do not respond to other treatment methods

Before going for surgery, a person should talk with a healthcare professional about what to expect during and after the procedure. They should ask about postsurgery care and what to expect during their recovery.

A person may need to have some downtime following the procedure. They may also need help with transport to and from the clinic or hospital, as well as extra help in the following days while they recover.

It is important to follow all instructions from a person’s doctor to help ensure a smooth recovery.

A 2022 study states that gout flares occur frequently after surgery. They suggest the risk of postoperative gout flare-ups is between 17.2% and 44.3%.

Factors that may increase the risk include:

  • high uric acid levels in their blood prior to the surgery
  • a history of smoking
  • lack of medical treatment for gout
  • lower hemoglobin levels before surgery
  • greater decreases in hemoglobin levels on the first day postsurgery

Key terms explained: Hemoglobin

Hemoglobin is a type of protein in a person’s red blood cells. It carries oxygen from the lungs to the body’s tissues.

Gout is a form of inflammatory arthritis that is very painful. It typically affects one joint at a time and often starts in the big toe, although it can appear in almost any joint or soft tissue in the body.

Symptoms in the joint may include:

  • swelling
  • redness or other color changes
  • heat
  • pain

Frequent flares of gout can lead to gouty arthritis, which is a more severe form of the condition.

Gout occurs when too much uric acid accumulates in the blood. The uric acid causes crystals to form in a joint, which causes pain and swelling. Flares can last between a few days and several weeks, although treatment may help shorten the duration of the symptoms.

Gout treatment involves a combination of therapies and lifestyle changes. Since there is no cure, treatment focuses on reducing symptom severity and preventing new attacks.

Doctors may prescribe medications to reduce uric acid in the blood, such as allopurinol and febuxostat, or pain-relief medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

In addition to medications, a doctor will likely recommend lifestyle changes, including:

During a flare, a person can use several methods to help control their symptoms. Treatment options may include:

  • OTC medications or prescription-strength NSAIDs
  • ice
  • elevation
  • rest
  • corticosteroids
  • colchicine

Gout is a common form of inflammatory arthritis. In many cases, a person can successfully prevent future flares with regular treatment and lifestyle changes.

A doctor may recommend surgery if symptoms get worse, large gout crystal deposits form, treatment no longer helps, or infection occurs.

There are three surgical options that can either restore function to the joint, remove deposits, immobilize a joint, or reduce pain.