Medical management for the different varieties of arthritis has improved tremendously over the last 20 years. However, there are still many patients for whom medical management either doesn't work or who progressive joint damage that requires surgical intervention.

The thought of surgery is frightening because of the many potential risks that can occur whenever general anesthesia and a major surgical operation are considered.

Here are some tips and questions to consider before proceeding with joint replacement surgery...

Sometimes there are conventional medicines that haven't been tried yet that might offer relief. You need to make sure your rheumatologist has looked at them all.

A change in dosage - ie. an increase- may be all that is required. Sometimes the use of two medicines together is a solution. There may be synergy.

Make sure all the different options other than surgery have been explored. Sometimes clinical research trials will offer a treatment that is very effective but that is currently not available to mainstream patients.

If surgery is a definite, then find out what the different surgical options that are available could be. Sometimes minimally invasive procedures will be involved and that would be a plus.

Do your homework! The internet is a great source of information.

Make sure you get at least two opinions.

Check out the credentials of the surgeon. What is his or her success rate? What is his or her complication rate?

How many procedures of the sort you're going to have do they do in a given year? A surgeon who only does one or two a month is not going to have the experience of one who does joint surgery daily.

Consider going to a pre-surgery class. Many hospitals now offer instruction on how to prepare for the operation and what to expect afterward. The classes are usually very instructive but even better, they let you interact with other people who are going to have the same type of procedure.

Ask about the potential risks. What are they and what are the relative odds? While this is no guarantee either way, it will give you a ballpark figure.

Find out where the surgery will be done. What is the infection rate at that institution?

How long is the surgical result supposed to last? When will it need to be repeated? What are the possible complications for a repeat operation?

What are the activity limitations immediately following surgery? What is the estimated time for rehabilitation and recuperation?

Will you need to go to a rehabilitation facility or will you be able to go directly home from the hospital?

If you are employed you will need to have a good idea as to how long you'll be out of work.

What types of educational material, ie. books, pamphlets, videos does the surgeon have to look at that might paint a clearer picture of the operation?

Are there other patients who have had the same type of surgery you can chat with to get a better idea as to what to expect?

Are there any preparations that will be required before surgery? For instance, patients will often be asked to bank their own blood before the operation.

Talk with your rheumatologist about your medications and ask whether you need to discontinue any of them prior to the operation. Often, rheumatologists will ask patients to temporarily discontinue methotrexate and biologic medications a few weeks before the anticipated operation. Non-steroidal anti-inflammatory drugs (NSAIDS) also need to be held a few days before surgery as well.