Arthrodesis (Joint Fusion)

Joint pain can be crippling, especially when traditional treatments don't work. Arthrodesis brings hope to many people who suffer from severe joint problems. This surgical technique creates a permanent fusion between two bones to stop painful movement and add stability. 

Doctors recommend arthrodesis surgery after conservative treatments for osteoarthritis prove ineffective. Modern joint replacement surgery has reduced its use, but the procedure remains the best option to treat end-stage osteoarthritis of the first metatarsophalangeal joint that causes hallus rigidus. Surgeons can apply this technique to joints throughout the body, including the spine, ankles, wrists, fingers, thumbs and feet. The fusion technique's main goal is to strengthen injured, weak or damaged joints while reducing pain by a lot.

What is Arthrodesis?

Arthrodesis, also known as joint fusion, permanently joins two bones in a joint. The orthopaedic surgeon straightens the damaged joint, removes the cartilage, and stabilises the bone. This allows it to heal as one solid structure. The procedure stops movement between bones and creates a stable foundation that can bear weight while relieving pain.

Arthrodesis Types 

Several fusion procedures exist based on the affected area:

• Triple arthrodesis: Fusion of subtalar, talonavicular, and calcaneocuboid joints
• Double arthrodesis: Fusion of two of the above three joints
• Isolated arthrodesis: Fusion of a single joint
• Pantalar fusion: Tibiotalar, subtalar, and talonavicular fusion

Doctors can perform this procedure on joints throughout the body, especially in the spine, ankles, feet, wrists, fingers and thumbs.

Symptoms of Arthrodesis

Pain stands out as the primary sign that suggests a need for arthrodesis. Patients might also experience: 

• Joint stiffness
• Limited mobility that reduces quality of life
• Nerve-related problems like tingling or loss of strength in extremities

When is Arthrodesis Surgery Needed?

Severe arthritis that wears away joint cartilage often leads to arthrodesis, as bones start rubbing against each other. This surgery becomes the last option after other treatments fail. Several conditions might require joint fusion:

Severe bone fractures that damage the joint bones

• Valgus or varus foot deformities
• Joint instability
• Rheumatoid arthritis
• Degenerative joint disease

Risk and Complications of Arthrodesis

Arthrodesis, like any surgery, comes with some risks. These potential complications include:

• Infections at the surgical site
• Bleeding or blood clots
• Nerve damage
• Hardware failure (broken rods or screws)
• Nonunion (bones failing to fuse properly)
• Painful scar tissue
• Arthritis developing in nearby joints

Recovery can take anywhere from several weeks to a year. The fused joint won't move anymore, but patients typically feel relief from pain.

Diagnosis for Arthrodesis

A proper diagnosis is vital before any arthrodesis procedure. Your doctor must verify that joint fusion will be the best way to relieve your pain.

• Physical exam: Your doctor checks the affected joint and assesses your movement. They also ask how symptoms affect your daily activities. 
• Blood analysis: Blood tests help eliminate inflammatory conditions or infections that could cause joint problems.
• Imaging:
  • X-rays show bone alignment and joint damage
  • MRI or CT scans give detailed images of soft tissues and bone structures
  • Doppler tests check blood flow around the joint

Some cases need joint fluid analysis to check for conditions like gout or tuberculosis. Image-guided injections are the most reliable diagnostic tool. These procedures put anaesthetic right into the joint. Pain that goes away temporarily confirms the joint as the source.

Treatment for Arthrodesis

Doctors first try non-surgical options—medications, physical therapy, bracing, or injections. Joint fusion becomes an option when these methods don't work. The procedure changes based on which joint needs fusion. Your surgeon removes damaged cartilage between bones and straightens the joint. They then secure the bones with metal hardware like screws, plates, or rods. Bone grafts often help healing - either using your own bone tissue (autograft) or donor/synthetic material (allograft).

Recovery times vary a lot. Small joint fusions might heal in weeks. Complex procedures like spinal fusions can take up to a year. You'll need pain management through prescription medications and over-the-counter options early on. Most patients use assistive devices like splints, crutches, or walkers while healing. The fused joint will have limited movement. Yet most patients see major pain reduction and better function, which makes daily activities easier.

Conclusion

Arthrodesis remains a great surgical choice for patients with severe joint pain. Joint replacement surgeries are common now, but fusion procedures are a reliable solution, particularly for conditions like hallux rigidus.

Your life changes after arthrodesis. The fused joint won't move, and this might feel odd initially. Most patients experience major pain relief that makes their daily tasks easier. Many find the trade-off between movement and comfort worth it, especially those who dealt with constant pain before.

The recovery process needs patience. Small joint fusions heal fast, while complex ones like spinal fusions just need more time. Your body adapts to its new structure, and assistive devices help you stay independent during this period.

Joint fusion surgery is a big decision. Talk openly with your surgeon about what to expect, possible complications, and recovery time. Ask how the procedure affects your daily activities and lifestyle. This knowledge helps you decide if arthrodesis is the right choice for your joint health.

FAQs

1. What is the difference between ankylosis and arthrodesis?

Ankylosis happens when bones in a joint fuse together naturally or as part of treatment. Arthrodesis creates ankylosis in a joint through surgery. The main difference lies in the approach—arthrodesis uses surgical implants to keep the joint stable while it heals, but ankylosis can happen without implants. The surgical approach also speeds up healing, creates better fusion results, and reduces pain during recovery.

2. What are the disadvantages of arthrodesis?

Joint fusion comes with several drawbacks to think over:

• You permanently lose joint movement and flexibility
• Recovery requires long periods without movement
• Bones might not fuse together properly
• Hardware can break or cause discomfort
• Nearby joints could develop arthritis
• Walking becomes less efficient, and some activities become harder

3. What is the recovery time for arthrodesis?

The joint's location affects recovery a lot. Complete healing takes 4 to 12 months. Smaller joints like fingers heal faster than complex areas like the spine. Patients who get triple arthrodesis wear a cast for 12 weeks first. They then start putting weight on the joint gradually and see the best results after one year.

4. What is the purpose of arthrodesis?

The main goal of joint fusion is to stop persistent pain that doesn't improve with standard treatments. The surgery makes weak or damaged joints stronger and more stable. It creates a solid structure that handles more weight without pain. This approach works well for severe arthritis, joint damage, injuries, and birth defects in joints.

5. What is the most common arthrodesis?

Severe arthritis tops the list of reasons for arthrodesis. The procedure happens most often in the spine, hand, ancle, and foot. Doctors use spinal fusion to treat long-term back pain, deformities, or unstable spines. Ankle arthrodesis helps patients with end-stage arthritis in the tibiotalar joint.

Dr. Jagan Mohana Reddy

FRCS (Trauma & Ortho), CCT – UK, MRCS (EDINBURGH), Diploma Sports Medicine UK, Postgraduate Diploma in Health Science
CARE Medical Center, Tolichowki, Hyderabad, CARE Hospitals, HITEC City, Hyderabad

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