Arthrodesis (Joint Fusion)
Joint fusion or arthrodesis is still a useful surgery in some conditions where the joint has been destroyed to the extent that it cannot be reconstructed and the replacement of the joint may not be available or involves higher risk. The common joints which get this arthrosed (fused) are ankle, big toe, mid foot and wrist. The aim of this surgery is to provide a painfree rigid joint in place of a painful and stiff joint.
When to get Arthrodesis done?
Osteoarthritis. Advanced stages of ankle arthritis with severe pain, limitation of mobility in a young and active patient.
Secondary Arthritis. Arthritis secondary to deformity post injuries around the joint in young patients.
What symptoms warrant surgery?
Limited mobility due to pain
Difficulty with activities of daily living due to stiffness and pain
Any surgery would involve certain risks, however the risks with arthrodesis are low.
Fracture. During the surgery there is a small risk of fracture of the bones adjacent to the joint.
Infection. Risk of infection is low with the advanced techniques and improvised theatre environment. Infection if picked up early, are likely to respond to antibiotics. In some instances it may need further washout or even removal of the implant.
Nerve Damage. Rare, but can lead to numbness or weakness down the limb. In most patients, that recovers within 3 months.
Clots in legs and lungs. To prevent clots (Deep vein thrombosis and pulmonary embolism), medications are given for first 45 days post-surgery.
Stiffness. Stiffness of the joint is a rule post arthrodesis rather than an exception. Arthrodesis leads to stopping the movements at that particular joint. Hence the stress can increase on the joints above and below.
Preparing for the surgery
A good control of medical conditions such as diabetes and blood pressure is required. In addition to that a thorough check up by the physician and advice regarding the dosage of the medications and any alterations to that the days before and after the surgery needs to be taken. Stopping smoking is necessary as smoking affects the healing of the surgical wound and the bones.
The surgery is either performed with injection in the back to numb the legs or alternatively under general anaesthesia where you are put to sleep for about the 1.5 hours of surgical time. The surgery is performed by clearing up the remaining cartilage in the joint and create the fresh edges of the bone which can fuse well and then fixed with either multiple screws or a nail.
Post-surgery you can expect to be in a plaster for 6 to 8 weeks till the bones fuse. Post that rehabilitation to help regain the muscle strength and joint mobility in the joints above and below are resumed. Once the bones have fused, the individual can resume heavy manual work as well.