Arthrodesis, commonly called joint fusion, is a surgical procedure in which two bones within a joint are permanently fused to create a single, solid bone structure. This is primarily done to relieve pain, correct deformities, or stabilise a joint that has become weakened or damaged due to various conditions.
Arthrodesis is commonly performed on weight-bearing joints, including the fingers, wrists, ankles, and spine. It is often considered when alternative therapies have not been able to relieve pain or restore joint function. This article provides a comprehensive overview of arthrodesis, covering its indications, procedure, types, and benefits.
Why is Arthrodesis Performed?
Arthrodesis is usually recommended for individuals suffering from chronic joint pain and dysfunction that has been unresponsive to other less invasive treatments. Common reasons for performing arthrodesis include:
Arthritis
Severe joint pain, inflammation, and cartilage degradation can result from diseases like osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. When the pain becomes debilitating, joint fusion may offer a solution by eliminating the damaged joint and thereby relieving pain.
Joint Instability or Deformity
Instability resulting from diseases, congenital abnormalities, or injuries that cause abnormal joint alignment can raise the risk of breaks or further injuries. Arthrodesis can stabilise the joint and correct misalignments.
Infections or Tumours
In situations where tumours or infections harm joint structures, removing the afflicted or infected tissue and then fusing the joint can help stop the disease from spreading and preserve structural integrity.
Trauma or Fractures
Severe joint injuries or fractures, especially those that do not heal properly, can lead to chronic instability and pain. Fusion can create a stable and pain-free joint in such situations.
Neuromuscular Disorders
Joint abnormalities and muscle imbalances can result from diseases like polio or cerebral palsy. Arthrodesis can stabilise afflicted joints and enhance their functionality.
Types of Arthrodesis Procedures
The specific type of arthrodesis performed depends on the location and condition of the joint. Some of the most common types of arthrodesis include:
1. Spinal Arthrodesis (Spinal Fusion)
One of the most common forms of arthrodesis is spinal fusion, especially for people with severe back pain because of conditions like degenerative disc disease, scoliosis, or spondylolisthesis. In the course of spinal fusion, two or more vertebrae are fused using bone grafts, metal plates, screws, or cages to create a single solid segment in the spine. This fusion stabilises the spine and alleviates pain caused by motion between the affected vertebrae.
2. Ankle Arthrodesis
Ankle fusion is commonly performed for patients with severe arthritis or trauma to the ankle joint, where the cartilage has been damaged beyond repair. In this procedure, the bones of the ankle joint, typically the talus and tibia, are fused using plates and screws to create a stable and pain-free joint. Ankle arthrodesis can improve the patient’s ability to bear weight on the leg and walk more comfortably.
3. Wrist Arthrodesis
Wrist fusion is often recommended for individuals with advanced arthritis or wrist instability. By fusing the bones of the wrist, pain is significantly reduced, although range of motion is compromised. Wrist arthrodesis can be partial (involving specific bones of the wrist) or total (fusing the entire wrist joint).
4. Finger and Thumb Arthrodesis
For people with rheumatoid arthritis, osteoarthritis, or traumatic injuries, fusion of the small joints in the fingers or thumbs can help reduce pain and improve grip strength. While joint movement is lost in the fused finger, patients often regain functional ability without pain.
5. Foot Arthrodesis
Foot fusions, including subtalar, midfoot, and toe fusions, are frequently performed for people with arthritis, flatfoot deformities, or traumatic injuries affecting foot joints. This type of fusion provides stability to the foot, corrects alignment, and allows better distribution of weight while standing or walking.
Procedure for Arthrodesis
Arthrodesis can be performed using various techniques, depending on the joint being fused and the patient’s circumstances. The typical steps in an arthrodesis procedure include:
Preoperative Preparation
Patients go through a comprehensive evaluation, which may include X-rays, CT scans, MRI, and blood tests, to assess the condition of the joint. They are also advised to stop smoking, as it can impair bone healing, and they might need to cease certain medications to minimise the risk of bleeding.
Incision and Joint Preparation
Once the patient has been put under anaesthesia, the surgeon makes a cut to access the joint. Damaged cartilage and other tissue are removed to prepare the bone surfaces for fusion.
Bone Grafting
The surgeon may use bone graft material to stimulate fusion. This graft may be made of synthetic materials, autograft (from the patient’s own body), or allograft (from a donor). To encourage the growth of new bone, the bone graft is positioned in between the bones that are being fused.
Stabilisation
The bones are stabilised with metal plates, screws, rods, or other devices to hold them in the correct position while they fuse. In some cases, external fixation (with screws and pins outside the skin) may also be used.
Closing the Incision
The incision is closed with sutures, and a cast or brace is applied to restrict movement in the fused joint and support the area during the healing process.
Recovery
Recovery after arthrodesis varies depending on the joint involved and the patient’s overall health. In general, the fusion process can take several months as the bones slowly grow together to form a single solid structure. Some key aspects of recovery include:
Immobilisation
Patients typically need to wear a cast or brace for several weeks or months to keep the joint stable and allow the fusion process to complete.
Physical Therapy
Physical therapy is often required to strengthen surrounding muscles, improve balance, and adjust to the loss of joint motion. Exercises may also focus on enhancing mobility in adjacent joints that now compensate for the fused joint.
Pain Management
Patients may receive prescription medications to manage their postoperative pain, which is expected. Icing and elevation can also help manage discomfort and reduce swelling.
Gradual Return to Activities
Patients are generally advised to avoid putting weight on the fused joint until the bone has been entirely healed, which can take up to 12 weeks or longer. Full recovery and return to normal activities often take six months to a year.
Benefits of Arthrodesis
Despite the risks, arthrodesis can provide significant benefits for individuals with severe joint pain or instability:
Pain Relief
By eliminating movement in the damaged joint, arthrodesis can effectively relieve pain, enabling patients to engage in daily activities without discomfort. This pain relief often leads to improved quality of life, as individuals can return to hobbies and tasks they once avoided due to pain.
Improved Stability
Joint fusion increases joint stability, which is particularly important for weight-bearing joints like the spine, ankle, and foot. With a more stable joint, patients experience better balance and a reduced risk of falls or further injury.
Enhanced Functionality
Although movement is lost in the fused joint, patients often regain the ability to perform activities that were limited by pain or instability before surgery. This enhanced functionality can lead to greater independence, as patients can manage daily tasks more effectively and confidently.
Durable Solution
Unlike joint replacement, which may wear out over time, joint fusion is generally considered a long-term solution that does not need to be revised or replaced. This durability means that patients are less likely to require additional surgeries, which can be both costly and physically demanding.
Conclusion
In conclusion, arthrodesis is a valuable surgical option for individuals suffering from severe joint pain, instability, or deformity that has not responded to other treatments. By permanently fusing bones within a joint, this procedure can grant long-lasting relief from pain, improve joint stability, and enhance functionality, particularly for weight-bearing joints. With proper recovery and adjustments, arthrodesis can lead to a significantly improved quality of life, making it a reliable solution for those with chronic joint conditions seeking a durable path to comfort and mobility.
