The term "arthrodesis" describes the surgical fusion of a joint so that it is no longer capable of movement. Basically, the arthrodesis procedure is an artificially induced fusion of bones across a joint (ankylosis) performed to relieve pain or provide support in a diseased (such as in osteoarthritis) or injured joint.
Arthrodesis has been used to create fusions that ultimately relieve pain and provide stability in the ankle, wrist, knee, shoulder, hip, spine, and other joints. By the time afflicted individuals present for surgery, they usually have little motion left in their arthritic joints and have adapted to living without the motion. Most of them are, therefore, grateful for the pain relief. As artificial joint replacements and implants improve, fewer arthrodesis procedures and more joint replacements are performed. |
Source: Medical Disability Advisor
| Arthrodesis is performed to control pain, to slow disease progression, to provide stability to a joint that has been damaged by arthritis or muscle weakness, and to correct deformity. Arthrodesis is also performed in individuals afflicted with poliomyelitis to reduce the number of joints the weakened or paralyzed muscles must control and to treat progressive spinal deformity that does not respond to nonoperative treatment. Finally, arthrodesis is performed to enable individuals to return to productivity after the initial healing period is over. |
Source: Medical Disability Advisor
The technique of the arthrodesis procedure varies according to its site (wrist, ankle, knee, hip, or shoulder joints), but what the surgeon needs to achieve for the procedure to succeed is basically the same in most arthrodesis procedures. In general, arthrodesis are performed with the individual under general or regional anesthesia and placed in a position that is conducive to the kind of arthrodesis being performed. Two different techniques are used to fuse bones in the joint. In both techniques, the surgeon makes an incision over the area to be treated and removes the joint surface on the bones on both sides of the joint (débridement). The purpose of the débridement of the bony surfaces is to increase surface contact area. For the first technique, the joint is then held stiff with a cast or metal hardware until the débrided bone ends grow together (intra-articular arthrodesis).
For the second technique, fusion of the bone ends is achieved by implanting bone grafts along the side of the joint (extra-articular arthrodesis). For both techniques, the joint must be kept immobile for a defined period of time to allow the fusion and healing to take place in and around the previous joint.
Anterior lumbar fusion in the spine involves removing the offending intervertebral disc and placing a bone graft between the vertebrae, which will then fuse together. In a posterolateral spinal fusion, the disc is not disturbed. The facet joints are excised, and bone graft is placed in the "gutter" on both the medial and lateral sides of the facet joints. In posterolateral interbody fusion (PLIF), discectomy is completed with placement of bone graft in the remaining disc space. A variation is transverse lumbar interbody fusion (TLIF), in which the approach is more lateral. |
Source: Medical Disability Advisor
Most arthrodesis procedures will bring pain relief. However, in spite of more advanced surgical techniques and better appreciation of blood supply preservation, a certain number of individuals will require additional surgery. The majority of individuals adapt to joint fusion and accept stability, comfort, and improved appearance in exchange for limited range of motion. For example, following wrist surgery, the individual will generally be pleased with pain relief and deformity improvement but may have difficulty lifting objects or positioning his or her hands for certain activities. For this reason, the procedure is relatively contraindicated in young, active individuals.
After knee surgery, the knee has stability, but the lack of any motion in the knee makes activities such as entering a car difficult.
Results following fusion of the lower back (lumbar spine) are less promising. Approximately two-thirds of individuals who undergo lumbar fusion will remain disabled 2 years later. Following the procedure, over half of individuals reported little or no change in their pain and ability to function ("Guidelines"). |
Source: Medical Disability Advisor
The hand, wrist, and ankle are more commonly seen for rehabilitation following an arthrodesis. It is important, however, to initially control postoperative pain and swelling for any joint fusion. This is followed by rehabilitating the individual to regain function of the body part involved. The physical therapist will use various methods to address postoperative symptoms.
Strengthening the muscles that move adjacent joints is important. For example, an individual who has undergone an arthrodesis of the hip would benefit from strengthening exercises for the muscles that move the back of the knee because these muscles must compensate for the loss of joint movement. This strengthening is important to improve an individual's gait. Instruction in the use of an assistive device such as a cane may be required shortly after surgery, while the individual progresses to independent walking. Strengthening exercises are equally important for any arthrodesis performed on the upper extremities.
Modifications may need to be made by the physical therapist for those who have arthritis or other conditions near the joint that underwent arthrodesis. Rehabilitation will also vary depending upon the body part and joint(s) involved. |
Source: Medical Disability Advisor
Complications of any arthrodesis include incomplete healing of the arthrodesis (nonunion, malunion), which may require revision surgery. Some surgeries may result in persistent localized swelling that generally resolves with time and benefits from elevation of the involved extremity. Postoperative infections and blood clots are potential complications of any arthrodesis procedure.
Complications specific to wrist arthrodesis include pain and tenderness around the plate that is often implanted during surgery, and tendon adhesions (Walsh).
Individuals who have undergone shoulder arthrodesis may have loss of elbow motion, but this usually is temporary. Later postoperative complications include incomplete healing of the fusion (nonunion), healing in poor position (malunion), painful hardware, and secondary onset of degenerative arthritis of the acromioclavicular joint.
Complications of hip arthrodesis include increases in stress in the lumbar spine, contralateral hip, and ipsilateral knee, all of which require greater energy expenditure for walking (ambulation). Premature onset osteoarthritis frequently develops in these joints due to the increased stresses or forces involved in activity such as walking. The extent of these complications is considerably greater for older, less than healthy individuals.
Complications following spinal fusion include failure to heal, resulting in a false, frequently painful joint (pseudoarthrosis). |
Source: Medical Disability Advisor
Accommodations and restrictions are intended to protect the site of arthrodesis until adequate healing has occurred. Restrictions and accommodations depend on the site of arthrodesis (i.e., ankle, wrist, knee, shoulder, hip, or back). Restrictions during recovery include limited or no use of the joint and extremity involved. Standing, walking, lifting, or carrying may need to be temporarily limited. Splints, short leg casts, postsurgical shoes, or braces may have to be worn; crutches or a cane may need to be used for a short time postoperatively. Frequent rest periods that include elevation of the involved extremity are conducive to earlier return to full-time work.
An important accommodation is a review of drug policies because the individual may be prescribed potentially sedating medication for pain control and inflammation. |
Source: Medical Disability Advisor
| Cited "Guidelines for Lumbar Fusion (Arthrodesis)." Washington State Department of Labor and Industries. 31 Oct. 2008 <http://www.lni.wa.gov/migration/ClaimsInsurance/Files/OMD/MedTreat/2002MTG31to39.pdf>.Walsh, John J., and Mark Harper. "Wrist Arthrodesis." eMedicine. Eds. Lee Osterman, et al. 25 Jun. 2008. Medscape. 17 Feb. 2009 <http://emedicine.medscape.com/article/1241236-overview>. |
| GeneralSchroeder, Stephen A., et al. "Triple Arthrodesis." eMedicine. Eds. Heidi M. Stephens, et al. 28 Feb. 2008. Medscape. 17 Feb. 2009 <http://emedicine.com/orthoped/topic354.htm.>. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|