Arthrodesis

As Arthrodesis is a deliberate surgical joint stiffening. This procedure is used in orthopedics and surgery and is usually the last option if 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?

Arthrodesis is a deliberate surgical joint stiffening. This procedure is used in orthopedics and surgery and is usually the last option if joint-preserving measures are no longer effective or useful.

Arthrodesis is a deliberate surgical stiffening of a joint. The anatomical function is completely prevented and blocked. Arthrodesis is often performed in the case of advanced arthrosis (joint wear) or if a joint is painful. This is to achieve a higher load capacity of the joint and a 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 arthrodesis) and extra-articular arthrodesis (the joint is not opened for arthrodesis). Temporary joint stiffening can be done surgically with a so-called K-wire.

The arthrodesis procedure is possible on any joint, but it is performed less and less. The reason for this is the increasing further development of the joint endoprosthesis. Most arthrodesis today are still performed on the shoulder, wrist, ankle, and middle ankle joints. Arthrodesis is a very successful surgical procedure for treating severe instabilities in hallux valgus or hallux rigidus. In principle, however, arthrodesis is permanent and cannot be reversed.

Function, effect & goals

Arthrodesis is indicated if there is advanced arthrosis in the joint and a total endoprosthesis is not possible. The loosening of an existing joint prosthesis is also indicated, provided it cannot be replaced or re-cemented. Often times, this procedure is also 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 a disease, such as in rheumatoid arthritis, this is also absolutely indicated for surgical arthrodesis. Large joints, such as the hip or knee joint, are tried to keep their anatomy and physiology as long as possible. The first alternative is to replace it with an artificial joint in order to maintain the patient's mobility and independence. Decisive for this are also the age, the possibly existing professional activity and the family environment.

The specialist decides whether 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 sensible in the long term. Furthermore, the complications and possible consequences must also be weighed up by the attending physician. If arthrodesis is performed, the joint is opened in most cases. In order to get to the joint, the tissue and soft tissue structures must be cut.

The articular cartilage is removed with a chisel or a milling cutter, thus smoothing the joint surfaces. This process is very important so that the ends of the joint-forming bones can be adequately brought together and connected in position. An osteosynthesis procedure is used to fix the ends together. The ends are fixed with screws and plates made of surgical steel. Once the bones are firmly fixed, the joint capsule is sutured again and placed around the bony ends.

Wound pain can occur postoperatively, which can be treated with medication if necessary. The sutures from the surgical wound are removed approximately 12 days after the operation. The wound care should be dry and sterile in order to avoid infections. If possible, the affected extremity should not be loaded until the ends of the bones have grown together. This may take three to four months and can be assessed using an X-ray. However, when and how much the extremity can be loaded is always decided by the treating specialist taking into account the patient's individual anamnesis and care history.

The extremity can be placed in a splint or a plaster cast until the bones have completely grown together. 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 massive effects on the anatomical and physiological function and structure of the joint. This carries risks that can have long-term consequences. Typical risks of 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 conditions, restricted movement of the entire extremity, sensitivity disturbances, material intolerance or a shortening of the extremity. In addition, the general risks of a surgical procedure must be taken into account. These can be nerve injuries, bleeding during surgery and also postoperatively.

It can also lead to large bruises that may need to be punctured or surgically removed. It can also cause tendon and muscle injuries, infection, and scarring. The risks of partial or general anesthesia should also always be considered.