Surgery for Gout: When Is It Recommended?

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With treatment, most people with gout can get their symptoms under control and enjoy full and active lives. Today, there are a wide variety of medications and therapies available to you. Working with your doctor, you can find those that help most at reducing the pain associated with gout attacks and preventing them from occurring in the first place. Treatments can also prevent your gout from advancing to a more damaging stage.

However, if you've had poorly controlled gout for 10 years or more, you may have developed chronic tophaceous gout. This is the most advanced and disabling stage of the disease. It can cause permanent damage to your joints as well as other parts of your body. In people with this type of gout, surgery may be the most helpful solution.

Here are three surgical options for chronic gout:

1. Tophus removal. Tophi are chalky, uric acid deposits that develop around joints and tendons in people who have had gout for many years. They're most likely to occur in the toes, fingers, hands, and elbows. They can also develop on bursae—fluid-filled sacs that provide a cushion between bones and soft tissues. Tophi may need to be removed because they are painful and inflamed. They're also dangerous because they can break open or develop an infection.

2. Joint fusion. Severe gout may permanently damage joints. If this occurs, smaller joints may need to be fused together to help relieve pain and increase joint stability.

3. Joint replacement. If gout has caused chronic pain in a joint, replacing that joint with an artificial one can relieve the pain. A replacement can help you move around more easily and reduce discomfort. For those who need a joint replacement due to gout, the knee is the most commonly replaced joint.

Remember that taking medications exactly as your doctor prescribes and making the lifestyle changes your doctor recommends can prevent gout from advancing. But if surgery is needed, these options can help you feel better and get back to living your life more fully. 

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Feb 27

  1. Gout, American Academy of Family Physicians (;

  2. Gout, American Academy of Orthpaedic Surgeons (;

  3. Gout, National Institute of Arthritis and Musculoskeletal and Skin Diseases (;

  4. Tophi Gout in Hand, National Library of Medicine, National institutes of Health (;

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