Arthrodesis is the term used to describe a deliberate surgical fusion of a joint. This procedure is used in orthopedics and surgery and is usually the last resort when joint-preserving measures are no longer effective or useful. However, there are also applications of arthrodesis where it is performed as a very successful therapy, such as for the widespread hallux valgus.
What is arthrodesis?
Arthrodesis is the term used to describe a deliberate surgical fusion of a joint. This procedure is used in orthopedics and surgery and is usually the last resort when joint-preserving measures are no longer effective or practical. Arthrodesis is a deliberate surgical stiffening of a joint. The anatomical function is completely prevented and blocked. Arthrodesis is often performed in cases of advanced arthrosis (joint degeneration) or painful instability of a joint. This is to achieve a higher load-bearing capacity of the joint and possible freedom from pain. The arthrodesis procedure was first performed by Eduard Albert in 1878. By stiffening the knee joints, E. Albert provided a girl with infantile paralysis with a secure footing again. In 1887, Eduard Albert successfully performed the first arthrodesis on the hip joint. Today, a distinction is made between intra-articular arthrodesis (the joint is opened for arthrodesis) and extra-articular arthrodesis (the joint is not opened for arthrodesis). Temporary joint fusion can be performed surgically using a device called a K-wire. The arthrodesis procedure is possible on any joint, but is being performed less and less frequently. The reason for this is the increasing development of joint endoprosthesis. Today, most arthrodesis is still performed on the shoulder joint, wrist joint, ankle joint and the middle foot joints. Arthrodesis is considered a very successful surgical procedure for the treatment of severe instability in hallux valgus or hallux rigidus. However, in principle, arthrodesis is permanent and cannot be reversed.
Function, effect and goals
Arthrodesis is indicated when there is advanced osteoarthritis in the joint and it is not possible to provide a total joint arthroplasty. Loosening of an existing joint prosthesis is also indicated if it cannot be replaced or re-cemented. This procedure is also frequently performed when there is general instability of a joint. This can also be disease-related, due to muscle paralysis of the extremity. If a joint is destroyed due to disease, such as rheumatoid arthritis, this is also absolutely indicated for surgical arthrodesis. Large joints, such as the hip joint or knee joint, are attempted to be preserved in their anatomy and physiology for as long as possible. The first alternative considered here is replacement with an artificial joint in order to preserve the patient’s mobility and independence. Decisive for this is also the age, the possibly existing occupational activity and the family environment. Whether an arthrodesis is indicated and whether the joint cannot be preserved in its function is decided by the specialist. This depends on the patient’s medical history, the condition of the joint and whether alternative interventions are effective and useful in the long term. Furthermore, the complications and possible consequences must also be weighed by the treating physician. If an arthrodesis is performed, the joint is opened in most cases. To access the joint, the tissue and soft tissue structures must be cut through. A chisel or a cutter is used to remove the articular cartilage, thus smoothing the joint surfaces. This procedure is of high importance so that the ends of the joint-forming bones can be adequately brought together and joined in position. To fix the ends together, a procedure called osteosynthesis is used. The ends are fixed with screws and plates made of surgical steel. Once the bones are stably fixed, the joint capsule is re-sutured and placed around the bony ends. Postoperative soreness may occur, which can be treated with medication if needed. Sutures from the surgical wound are removed approximately 12 days postoperatively. Wound care should be dry and sterile to prevent infection.If possible, the affected limb should not be loaded until the bone ends have fused together. This may take three to four months under certain circumstances and can be assessed on the basis of an X-ray. However, it is always the treating specialist who decides when and how much the limb can be loaded, taking into account the patient’s individual medical history and course of treatment. Until the bones have fully fused together, the extremity can be supported in a splint or cast. In addition, assistive devices, such as forearm crutches or even a temporary wheelchair, may be prescribed.
Risks, side effects, and hazards
Arthrodesis is a surgical procedure that has a massive impact on the anatomical and physiological function and structure of the joint. This carries risks that can have long-term consequences. Typical risks of arthrodesis include the formation of pseudarthrosis. This means that a so-called false joint can form in the area of the stiffened joint. Furthermore, chronic pain conditions, movement restrictions of the entire extremity, sensory disturbances, material intolerance or a shortening of the extremity can occur. In addition, the general risks of a surgical procedure must be considered. These may include injury to nerves, bleeding during surgery and also postoperatively. Furthermore, there may be large bruises that may need to be punctured or surgically cleared. There may also be injury to tendons and muscles, infection and scarring. The risks of partial or general anesthesia should always be considered as well.
