When Is Gout Surgery Necessary?

Gout is a type of inflammatory arthritis that occurs when crystals of uric acid build up in one or multiple joints in the body. This condition typically arises without warning and can cause sudden and intense pain.

While gout is traditionally managed conservatively with medication and lifestyle changes, this is not always effective. In rarer cases, more advanced and debilitating versions of the disorder may need to be treated surgically.

Learn more about when gout surgery may be necessary.

Senior man with gout
 Peter Dazeley / Getty Images

When Surgery Is Needed

Surgery to treat gout is considered to be a last resort, and there are a variety of other treatment options that are available. During an acute gout attack, treatment options include:

  • Medications like NSAIDs or oral corticosteroids are frequently utilized to help reduce the pain and inflammation associated with a flare-up.
  • A corticosteroid injection may also be administered into the affected joint by your doctor to reduce symptoms.
  • A medication called colchicine is frequently prescribed and can be useful in reducing the buildup of uric acid and relieving pain. This particular drug is normally only helpful if taken shortly after the onset of symptoms.

Other treatments can help reduce your chances of a gout attack reoccurring and decrease the formation of tophi. Medications like Allopurinol, Febuxostat, and Pegloticase help lower the likelihood of a painful flare-up and the subsequent joint destruction. These medications work by decreasing the systemic levels of uric acid in the body.

Lifestyle modifications may also be helpful in decreasing the frequency of your gout attacks. Being overweight and consuming too much alcohol puts you at a higher risk for a flare-up.

In addition, uric acid is formed in the body when a substance called purine is broken down. In fact, it is estimated that 20% of the body’s uric acid is formed from purines ingested from food. Because of this, avoiding certain foods with high purine levels can also be helpful in managing your gout. Foods that contain high amounts of this substance include:

  • Organ meat (liver, kidney, heart, etc.)
  • Mussels, scallops, herring, sardines, salmon, trout, and anchovies
  • Yeast
  • Veal, goose, turkey, bacon, and pheasant

Unfortunately, not everyone is able to control their gout with the treatments noted above. In some cases, chronic gout attacks can severely damage the lining of a joint. This can lead to significant pain or range of motion limitations and cause:

  • Infection
  • Ulceration of the skin
  • Compression or entrapment of a nerve in the area

In each of these situations, surgical intervention may be necessary.

Types of Gout Surgery

Depending on the joint that is affected and the amount or type of damage that is done, one of several surgeries may be performed to treat your gout symptoms.

While each individual’s circumstances are unique, the most common surgical interventions for this condition are detailed below.

Tophi Removal

Tophi nodules are frequently located in areas of the body where movement occurs. In addition to being situated around your joints, they can also form near tendons or bursae. Because of this, the tophi are prone to breaking open, which can lead to drainage or infection in an area.

The nodules can also become chronically inflamed from the friction associated with movement. As a result, an arthroscopic tophi removal surgery may be necessary to reduce the likelihood that one of these complications occurs.

This procedure is most commonly performed on tophi nodules around the fingers or toes, though it may be needed in other areas of the body as well.

Joint Fusion

Over time, uric acid crystals can break down the smooth, slippery cartilage that lines a joint and severely impairs your movement. This damage not only restricts your range of motion, but can also make everyday activities extremely difficult and painful to perform. To help counter this unfortunate consequence of gout, joint fusion (or arthrodesis) surgery may be needed.

This type of procedure involves placing screws and plates over a joint to permanently restrict the bones from moving. In doing so, it helps eliminate the pain that arises when damaged bones slide against one another.

Fusion procedures are typically only performed on the smaller bones of the hands and feet. This is because these areas have multiple other joints that can help compensate for the newly restricted motion.

Joint Replacement

In larger joints that are damaged by gout, a joint replacement (arthroplasty) procedure may be necessary. This intervention involves surgically removing the damaged portion of a joint and replacing it with prosthetic components.

By creating an artificial joint, a surgeon can significantly improve the range of motion and pain in a gout-affected region. While the knee is the most frequently replaced joint, an arthroplasty can actually be performed in many different areas, including the shoulder, elbow, and ankle.

Risks or Contraindications

Surgical treatment of gout can lead to significant improvements in symptoms, however it is important to know that these interventions are not without risk. In spite of their potential to elevate daily function and reduce pain, in rare situations joint replacement surgeries can lead to worsening pain or weakness in the area.

Who Is at a Greater Risk?

People who are overweight or have other illnesses are at a greater risk for complications.

In the case of surgical fusions, the small risk of continued pain in the area is also present. In addition, because the surrounding joints are exposed to new and greater stresses once an area of the body is fused, osteoarthritis can develop more quickly in these adjacent joints over time.

Finally, as with any surgery, there is always a small risk of infection or even death any time you undergo an operation. To mitigate this risk, surgery is usually contraindicated in people with active infections, osteomyelitis, or severe peripheral artery disease.

If you have questions about these treatment options or if you are unsure if you are a candidate, it is a good idea to speak to your physician about your specific case.

Prognosis

In spite of the severe pain associated with a gout flare-up, the various uric acid-lowering medications available are generally effective in managing this condition. The success of these drugs, along with lifestyle changes, make the development of tophaceous gout a relatively rare event.

In spite of this, however, a small number of people are unable to control this inflammatory condition and require surgical intervention. Fortunately, the procedures detailed above are largely successful at decreasing the symptoms caused by either tophi or joint damage. In addition, most individuals who undergo surgery report improved overall function afterward.

Preparing for Surgery

While gout-related surgeries are generally effective, it is important to prepare yourself beforehand to ensure a successful result. Preparation includes:

  • Speaking to your doctor about the medications you are currently taking and making them aware of any allergies you may have. This will help ensure that your post-operative pain can be effectively managed by your care team.
  • Trying to get as healthy as possible before your procedure. Refraining from smoking beforehand can help improve your healing and reduce your risk of infection afterward. In addition, working to lose any excess weight can help decrease the stress placed through the affected joint while you recover.
  • Arranging your home in a way that makes it easy to get around after surgery. For instance, you may want to set up a ground-floor bedroom to eliminate the need to climb stairs immediately afterward.
  • Having a friend or family member available to assist you in the days immediately after the procedure.

A Word From Verywell

In an effort to avoid painful flare-ups and eventually surgery, it is very important to actively manage your gout. This includes maintaining healthy body weight, avoiding excessive alcohol intake, and eating a healthy diet that includes complex carbohydrates (like vegetables and whole grains) and protein-rich dairy items (like greek yogurt or milk).

It is also crucial to work with your doctor to ensure that your uric acid levels are being monitored appropriately, using medication to lower them if needed. While the symptoms associated with this condition can be severely debilitating, taking these simple steps can help reduce your chances of a painful gout attack interrupting your day! 

Was this page helpful?
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kasper I, Juriga M, Giurini J, Schmurling R. Treatment of tophaceous gout: when medication is not enough. Seminars in Arthritis and Rheumatism. 2016;45(6):669-674. doi:10.1016/j.semarthrit.2016.01.005

  2. Johns Hopkins Arthritis Center. Treatment of gout.

  3. American Academy of Orthopaedic Surgeons. Gout. Updated December 2020. 

  4. American Academy of Orthopaedic Surgeons. Preparing for joint replacement surgery. Updated April 2020.