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Joint fusion (arthrodesis)
Arthrodesis is a surgical procedure that permanently fuses a damaged or arthritic joint in the finger, hand, or wrist, eliminating painful movement at that joint. It is typically considered when arthritis, injury, or instability has made the joint too painful or unstable for other treatments, trading joint motion for pain relief and improved stability.
At a glance
Anaesthetic
Sedation or general anaesthetic — varies by joint being fused
Where
The Avenue Hospital
Day case or overnight
Day case or overnight, depending on which joint is fused and your circumstances
First post operative review
Approximately one to two weeks after surgery
Driving
Not while in the post-operative splint or cast; varies by joint and hand dominance
Post Operative Hand Therapy
Required for splinting and rehabilitation
Splinting
Yes - splint or cast worn for some weeks after surgery; duration depends on which joint is fused, the method of fixation, and your healing on follow-up x-rays
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially.
Return to repetitive & heavy loading
Varies by joint fused; guided by follow-up x-rays confirming the bones have fused
Surgical fusion of a joint to relieve pain when the joint cannot be otherwise repaired
Joint fusion (arthrodesis) is surgery to fuse a joint in the hand or wrist so that it no longer moves, most often performed for severe arthritis or joint instability where pain limits daily activities and the joint itself cannot be made better.
This page covers fusion generically – in your consultation Dr Tomlinson will tailor the detail to the specific joint being treated (for example wrist, thumb base, or a finger joint).
Who is this procedure for?
- People with severe osteoarthritis, post-traumatic arthritis or rheumatoid arthritis causing pain that limits daily activities
- People with joint instability or recurrent dislocation where the supporting ligaments cannot be repaired
- People for whom joint replacement is not considered durable enough for their age or activity level, or where a joint replacement is not a suitable option
- Not usually recommended where non-surgical treatment or a joint-preserving procedure remains a reasonable option
What does the surgery involve?
The joint is opened and any remaining cartilage or damaged joint tissue is removed. The two bones are placed together in a position considered optimal for your future use, and held in that position with internal fixation such as a compression screw, wires, a plate and screws, or a specialised staple.
In some circumstances a bone graft – usually taken from the radius bone in the wrist, and occasionally from the hip or a synthetic source – is used to improve the chances of successful fusion. The fixation hardware is generally left in place permanently.
Alternatives to surgery
Joint fusion is one option for severe joint arthritis or instability. Depending on your situation, the alternatives may include:
- Doing nothing for now (watchful waiting): reasonable if pain remains manageable with non-surgical measures
- Non-surgical management: activity modification, splinting and corticosteroid injections
- A different procedure: joint replacement (arthroplasty), which preserves movement but is generally less durable for younger, more active patients and is more difficult to revise if it fails; for thumb base arthritis, trapeziectomy is another alternative
What happens if left untreated: pain and functional limitation typically continue or worsen as the arthritis or instability progresses.
Dr Tomlinson will discuss which options suit you and your specific joint at your consultation. For a fuller explanation of the underlying condition, see the relevant condition page, for example Wrist Osteoarthritis.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves and which joint is fused. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need longer. Dr Tomlinson will give you advice tailored to your job and joint at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for six weeks after the procedure.
When can I do a full day of administrative or desk work?
From 2-8 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A splint or cast is worn for some weeks after surgery. The exact duration depends on which joint is fused, the method of fixation used, your planned activities, and whether follow-up x-rays show good signs of healing.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Hand therapy is often recommended after joint fusion, particularly for wrist fusion, and Dr Tomlinson will give you a referral if appropriate.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Nonunion, where the bones fail to fuse and further surgery may be needed
- Malunion, where the joint fuses in a less-than-ideal position
- Prominent hardware (screws, wires or a plate) that is uncomfortable and needs removal
- Permanent loss of movement at the fused joint – this is the intended result of surgery, not a complication, but it cannot be reversed
- For wrist fusion specifically: irritation or rupture of the extensor tendon running across the plate, and numbness from nerve irritation during the approach
- Increased strain on neighbouring joints over time
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 72 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review, and your hand elevated in a sling. Do not lift or grip objects with the treated hand.
Second week
You will typically be in a splint or cast during this period, protecting the fusion site while early healing occurs.
6 weeks
After 6-8 weeks an x-ray will assess your progress in terms of bone healing and fusion, and after this time you will often be able to wean from your splint under the guidance of your hand therapist, and resume strengthening exercises and a more normal daily activity level. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The fusion site will continue to gain greater strength. Scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Most times the screws, wires or plate are intended to stay in position permanently and do not need to be removed. Recovery timeframes vary considerably depending on which joint was fused.
Want to know more about Joint Fusion (Arthrodesis)?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.