What is arthodesis and when is it recommended?

Arthrodesis: Definition and Recommendations

Arthrodesis is a surgical procedure that involves the fusion of two bones in a joint to relieve pain and improve stability. 1

What is Arthrodesis?

• Arthrodesis (joint fusion) is a surgical technique where the cartilage between joint surfaces is removed to promote bone growth across the joint, resulting in permanent fusion 2
• The procedure eliminates motion at the affected joint, providing pain relief and stability by converting a painful, unstable joint into a stable, painless structure 2, 3
• It is considered one of the last surgical options available when a joint is not amenable to reconstructive measures 2

Indications for Arthrodesis

Arthrodesis is recommended in the following clinical scenarios:

• Failed total joint arthroplasty when revision arthroplasty is not feasible 2
• Periarticular tumors affecting joint stability and function 2
• Posttraumatic arthritis with severe joint destruction 2
• Chronic joint infection that cannot be managed with other interventions 2
• Severe ligamentous instability or bone loss with deformity that cannot be addressed with less invasive procedures 1, 4
• Neuropathic joints with significant destruction, as these cases are technically challenging and delaying surgery increases technical difficulty 4
• Severe thumb base osteoarthritis refractory to conservative treatments with marked pain and/or disability 5

Contraindications

• Bilateral joint involvement is a primary contraindication, as fusion of both joints in the same limb pair would severely limit function 2
• Ipsilateral hip arthrodesis is a contraindication for knee arthrodesis as it would severely restrict lower limb function 2

Surgical Techniques

• Various techniques have been developed for arthrodesis, including:

  • External fixation methods 2
  • Internal fixation using compression plates 2
  • Intramedullary fixation through the joint 2
  • Antegrade nailing (for specific joints) 2
  • Intraosseous devices (particularly for foot and ankle arthrodesis) 6

• The basic principles of arthrodesis include:

  • Limiting fusion to the minimum number of joints necessary 3
  • Congruent denuding of articular surfaces to enhance fusion 3
  • Adding bone grafting when indicated to promote fusion 3
  • Considering tendon transfers to prevent recurrent deformity 3

Potential Complications

• Infection is a significant risk following arthrodesis, which may require:
  • Oral antibiotics for superficial infections 7
  • Hardware removal and surgical revision for deep infections or osteomyelitis 7
• Non-union may occur, requiring revision surgery 7
• Adjacent joint degeneration due to altered biomechanics and increased stress 2
• Functional limitations due to loss of joint motion 2

Clinical Decision Making

When considering arthrodesis, the following algorithm should be followed:

1. Exhaust conservative options first including:

   • Activity modification and education 5
   • Physical therapy and exercise regimens 5
   • Oral analgesics and topical NSAIDs 5
   • Corticosteroid injections for painful flares 5

2. Consider less invasive surgical options before proceeding to arthrodesis 4

3. Proceed to arthrodesis without delay in cases of:

   • Severe ligamentous instability 1, 4
   • Neuropathic joints with significant destruction 4
   • Failed total joint arthroplasty with infection 2

4. Select the appropriate arthrodesis technique based on:

   • Joint involved 6
   • Underlying pathology 2
   • Bone quality and available bone stock 2
   • Patient's functional requirements 7

For patients with realistic expectations, arthrodesis can effectively relieve pain and provide joint stability when other treatments have failed 2.