What is arthrodesis?
Arthrodesis is the deliberate surgical stiffening of a joint. The most common reason for the operation is advanced arthrosis (“joint wear”). Due to the destruction of the joint surfaces, the affected joint becomes increasingly unstable and painful.
The aim of arthrodesis is thus to relieve pain and to achieve a permanently high load-bearing capacity of the joint. However, the normal joint function is abandoned for this purpose. An arthrodesis can also no longer be reversed.
When is an arthrodesis performed?
Common reasons for an arthrodesis are:
- advanced arthrosis of small joints (fingers, wrist, toes and ankle)
- loosening of artificial joints without the possibility of replacement
- chronic instability of a joint due to muscle paralysis
- joint destruction in rheumatoid arthritis (“joint rheumatism”)
Arthrodesis is rarely performed on the large joints, such as the hip joint. In this case, an attempt is made to maintain the patient’s mobility for as long as possible by means of an artificial joint.
What is done during an arthrodesis?
Two anesthetic procedures are available for performing an arthrodesis: general anesthesia and spinal anesthesia.
With general anesthesia, the anesthesiologist puts the patient into a deep sleep and administers painkillers and muscle relaxants. In spinal anesthesia, the pain-conducting nerve pathways in the spinal cord are turned off by targeted injections of anesthetic, but the patient remains conscious during the procedure and receives only sedative medication.
For ankle surgery, a local nerve block, along with a mild general anesthetic, may be sufficient. The nerve block lasts for more than 20 hours, so the patient is virtually pain-free for several hours after surgery.
If the chosen anesthesia is effective, the skin at the site of the procedure is thoroughly disinfected. In addition, the body areas are covered all around with sterile drapes. Then the actual procedure can get underway.
Arthrodesis: Basic principles of the surgical procedure
In arthrodesis, the surgeon first gains access to the joint: to do this, he cuts through the skin, subcutaneous fatty tissue and muscles and opens the joint by cutting open the joint capsule.
To do this, he inserts screws or metal plates, for example, and sometimes the patient’s own bone chips (from the iliac crest, for example). Once the bones are firmly connected, the surgeon sutures the joint capsule as well as the subcutaneous fat and skin with a suture.
Example: Triple arthrodesis
In this surgery, the lower ankle joint in the foot and the two adjacent joints above and below it are stiffened.
To do this, the surgeon first removes the articular cartilage of the lower ankle joint and the two adjacent joints. He connects the now exposed joint surfaces with two to four strong screws. The correct position of the screws is checked on x-ray images. After the triple arthrodesis, the surgeon closes the wound with a suture and applies an elastic bandage.
As a result of the healing processes on the bone and the tension built up by the screws, three bones that can move individually against each other become, in a sense, “one bone” over time.
What are the risks of arthrodesis?
Surgical joint fusion involves special risks:
- formation of a false joint (pseudarthrosis)
- chronic pain
- Restriction of movement
- Sensitivity disorders
- material incompatibilities
- slight shortening of the operated arm or leg
Furthermore, as with any surgery, there are general surgical risks associated with arthrodesis:
- Bleeding during or after the operation
- Formation of a hematoma, which may need to be cleared out in another operation
- infections
- aesthetically unsatisfactory scars
- allergic reactions to materials used (plasters, latex, medicines)
- anesthesia incidents
What do I have to consider after an arthrodesis?
After the operation, a significant soreness is normal. Your doctor will prescribe an analgesic medication for you to take as needed after you are discharged from the hospital.
Stitches are usually removed on the tenth to twelfth day after arthrodesis. Until then, make sure that the surgical wound does not get wet or dirty. You should only shower while leaving the wound area out of the way. Alternatively, you can also use a special shower plaster.
Stress after arthrodesis
After an arthrodesis, you should first take it easy on the affected body part until the bone has healed. Depending on which joint the arthrodesis was performed on, this may take three to four months. Talk to your doctor about how much weight you can put on the operated joint until then.
Which aid is suitable for you personally depends on the underlying disease, the condition of the bone and the localization of the arthrodesis.
