Arthrodesis – Treatment, Effect and Risks
Arthrodese
Arthrodesis is a deliberate surgical stiffening of the 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 areas of application for arthrodesis where it is carried out as a very successful therapy, such as in the widespread hallux valgus .
What is arthrodesis?
An arthrodesis is a deliberate surgical stiffening of a joint. The anatomical function is completely prevented and blocked. An arthrodesis is often carried out in the case of advanced arthroses (joint wear) or painful instability of a joint. This is intended to increase the resilience 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 gave a girl with polio 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 the arthrodesis) and extra-articular arthrodesis (the joint is not opened for the arthrodesis). A temporary stiffening of the joint can be done surgically with a so-called K-wire.
The procedure of arthrodesis is possible on any joint, but it is performed less and less frequently. The reason for this is the increasing further development of joint endoprostheses. Most arthrodeses today are still performed on the shoulder , wrist , ankle and medial ankles . Arthrodesis is considered to be a very successful surgical procedure for the treatment of severe instability in hallux valgus or hallux rigidus . In principle, however, an arthrodesis is permanent and cannot be reversed.
Function, effect & goals
Arthrodesis is indicated when there is advanced arthrosis in the joint and treatment with a total endoprosthesis is not possible. The loosening of an existing joint prosthesis is also indicated if it cannot be replaced or re-cemented. This procedure is also often performed when there is general instability of a joint. This can also be due to illness, due to muscle paralysis of the extremities.
If a joint is destroyed due to illness, such as rheumatoid arthritis , this is also absolutely indicated for an operative arthrodesis. Large joints , such as the hip joint or knee joint, are attempted to retain their anatomy and physiology for as long as possible. The first alternative considered here is replacement with an artificial joint in order to maintain the patient’s mobility and independence. Decisive for this is also the age, the possible existing professional activity and the family environment.
The specialist decides whether an arthrodesis is indicated and whether the function of the joint cannot be preserved. 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 up by the attending 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 severed.
The articular cartilage is removed with a chisel or a cutter and the joint surfaces are smoothed. This process is of great importance so that the ends of the articulating bones can be adequately brought together and locked in place. A method of osteosynthesis is used to fix the ends together . The ends are fixed with surgical steel screws and plates. Once the bones are firmly fixed, the joint capsule is sewn up again and wrapped around the bony ends.
Postoperative wound pain can occur, which can be treated with medication if necessary. The sutures from the surgical wound are removed about 12 days postoperatively. Wound care should be dry and sterile to avoid infection. If possible, the affected extremity should not be loaded until the bone ends have grown together. This can sometimes take three to four months and can be assessed using an X-ray. However, the treating specialist always decides from when and how much the extremity can be loaded, taking into account the patient’s individual medical history and the course of care.
The limb can be placed in a splint or cast until the bones are fully fused . In addition, aids such as crutches or even a temporary wheelchair can be prescribed.
Risks, side effects & dangers
Arthrodesis is a surgical procedure that has a massive impact on the anatomical and physiological function and structure of the joint. This poses risks that can have long-term consequences. Typical risks of an arthrodesis are, for example, the formation of a pseudarthrosis .
This means that a so-called false joint can form in the area of the stiffened joint. Furthermore, it can lead to chronic pain, restricted movement of the entire extremity, sensory disturbances, material intolerance or a shortening of the extremity. In addition, the general risks of an operative intervention must be taken into account. These can be nerve injuries , bleeding during the operation and also postoperatively.
Furthermore, there can be large bruises that may need to be punctured or surgically removed. Injuries to tendons and muscles , infections and scarring can also occur. The risks of partial or general anesthesia should always be considered.
Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.