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Arthrodesis: Joint Fusion Surgery Explained

Arthrodesis is a surgical procedure that permanently fuses a joint to relieve pain and improve stability. It is used when a joint is severely damaged and other treatments have failed.

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Things worth knowing about "Arthrodesis"

Arthrodesis is a surgical procedure that permanently fuses a joint to relieve pain and improve stability. It is used when a joint is severely damaged and other treatments have failed.

What is Arthrodesis?

Arthrodesis, commonly known as joint fusion, is a surgical procedure in which two bones forming a joint are permanently fused together. The goal is to eliminate painful movement at the joint by allowing the bones to grow into a single, solid unit. While the procedure results in a permanent loss of joint mobility, it provides significant pain relief and long-term stability.

Indications – When is Arthrodesis Performed?

Arthrodesis is typically considered when conservative treatments have been exhausted and the joint is severely damaged. Common indications include:

Advanced osteoarthritis with debilitating pain
Rheumatoid arthritis with severe joint destruction
Post-traumatic joint damage following injuries or infections
Joint instability or deformity
Severe joint infections (septic arthritis)
Failed joint replacement (prosthesis failure)

Arthrodesis is most commonly performed on the spine (spinal fusion), the ankle, the foot joints, the wrist, and smaller joints of the fingers and toes.

Surgical Techniques

During arthrodesis, the cartilage is completely removed from the joint surfaces so that the exposed bone ends can grow together. The bones are then held in position using various fixation methods:

Screws and plates (internal fixation)
Intramedullary nails (nail fixation through the bone canal)
External fixator (external frame stabilization)
Bone grafting to promote new bone growth

The procedure can be performed as open surgery or minimally invasively (arthroscopic approach), depending on the joint involved and the extent of the damage.

Recovery and Healing

Following arthrodesis, thorough post-operative care is essential. Bone fusion typically takes three to six months. During this period, the joint must be immobilized using casts, orthotic braces, or specialized footwear. Physical therapy is a key component of rehabilitation, helping to strengthen surrounding muscles and maintain the function of adjacent joints.

Benefits and Risks

Advantages of Arthrodesis

Reliable and lasting pain relief
High joint stability after fusion
Long-term durability without the need for joint replacement

Possible Risks and Complications

Non-union (pseudarthrosis): Failure of the bones to fuse properly
Infection at the wound site or in the bone
Nerve or vascular injury during surgery
Increased stress on adjacent joints due to altered biomechanics
Permanent loss of joint mobility
Deep vein thrombosis or pulmonary embolism during recovery

Arthrodesis vs. Joint Replacement (Arthroplasty)

Arthrodesis and joint replacement (arthroplasty) are two different surgical approaches for severely damaged joints. While arthroplasty preserves joint movement, arthrodesis sacrifices mobility in favor of stability and pain elimination. The choice between the two depends on the patient's age, activity level, the joint involved, and overall health status. For certain joints – such as the ankle or small foot joints – arthrodesis may be preferred over prosthetic replacement.

References

Canale, S.T., Beaty, J.H. (Eds.): Campbell's Operative Orthopaedics, 13th Edition. Elsevier, Philadelphia, 2017.
Buckwalter, J.A., Saltzman, C., Brown, T.: The impact of osteoarthritis: implications for research. Clinical Orthopaedics and Related Research, 2004; 427: S6–S15.
National Institute for Health and Care Excellence (NICE): Osteoarthritis: care and management. Clinical guideline CG177. NICE, London, 2014. Available at: www.nice.org.uk/guidance/cg177

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