Melbourne Hand Surgery

Joint fusion - arthrodesis

What is an arthrodesis?

An "arthrodesis" is a medical word for "joint fusion". If a surgeon offers you the option of an arthrodesis it means that she or he is offering to fuse the joint so that it no longer moves.

Why would someone have an arthrodesis?

handscuttinglettuce 200x150An arthrodesis may be recommended to you for a number of reasons. Most commonly it is because your joint is painful and because the joint cannot be made better. Sometimes it is because your joint is very unstable and the ligaments or other structures that usually keep the joint in alignment are beyond repair.

An arthrodesis, or joint fusion, can be very beneficial if you have severe arthritis with pain that limits your daily activities. The downside of an arthrodesis is that you lose the movement of the joint. However, if you are able to use your hand and wrist without pain that will, overall, increase your ability to do all the activities that you have not been able to do.

Diagnoses that may lead to a recommendation for an arthrodesis include:

  • osteoarthritis
  • post traumatic arthritis
  • rheumatoid arthritis
  • joint instability or recurrent dislocations

Why would you have an arthrodesis and not a joint replacement?

Durable joint replacements for the hand and wrist are still being developed. Of all of the joint replacement options that are available, none of them are sufficiently advanced that Dr Tomlinson can advise a young, active individual that the joint replacement will be able to withstand the forces of the activities of the next 10 years. For many people, especially younger individuals, a joint fusion is a much more practical solution than a joint replacement.

However, some people prefer to opt for the joint replacement option. These people choose this option to maintain their range of movement, despite knowing that it is highly likely that they will require revision surgery (and likely arthrodesis) in the future, and that such revision surgery will be more difficult. At Melbourne Hand Surgery we will discuss your options with you, so that you can make an informed choice.

How is arthrodesis surgery performed?

wristarthritisfromRadiopaediaDOTorgIn the surgery the joint is opened up and any remaining cartilage or joint tissue is removed. The two bones are then placed together, in a position ("alignment") that is considered to be optimal for your future use. Sometimes this position is determined by your surgeon in consultation with you. Occasionally, such as in a wrist fusion, the position may be determined predominantly by the shape of a pre-molded plate.

When surgery is performed to fuse a joint it is necessary to hold the two pieces of bone in a fixed position while they fuse to form one. This fixation is provided with some type of internal metal - a compression screw, wires, a plate and screws or even a special staple (eg an OSStaple). Which method of fixation is used differs according to which joint is being fused and the surgeon's preference and experience. For example, for the wrist in the x-ray above the standard method would be to used a pre-formed plate with screws. In exceptional circumstances an external fixation device may be used in an arthrodesis, but this is not common and is generally unnecessary in planned surgery where there is no infection. 

It is common to use a bone graft in arthrodesis surgery, to improve the chances of successful surgery and also to maintain the bones at a relatively normal length. In hand surgery the bone graft is generally taken from the radius bone in the wrist, but it may be taken from the hip. Occasionally synthetic bone graft material may be used. Your surgeon will tell you exactly how your surgery will be done. 

Most times the screws, wires or plates will be planned to be in position permanently, so you will not need to have them removed. 

After the surgery is performed you will usually be placed in a splint or a cast for some weeks. The duration of splinting or casting depends on what joint is involved, what the method of fixation is, what activities you plan to undertake and whether your follow-up x-rays show good signs that the bones are healing. 

What are the risks of arthrodesis surgery?

The main risk or complication is that the joint may not fuse because the two ends of bone don't fix together solidly. If this happens then the arthrodesis has failed.

Other risks or complications that can happen with all surgery include infection (which is uncommon, but which can make it more likely that the bone ends don't fuse), bleeding, scarring, pain and stiffness.

How do I find out more?

If you would like to find out more about your treatment options please contact Melbourne Hand Surgery to arrange an appointment to see Dr Jill Tomlinson.

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