How Arthrodesis (Joint Fusion) Can Treat Advanced Arthritis

Arthrodesis is a surgical procedure that fuses two bones together. It is sometimes also called a joint fusion.

After arthrodesis, your joint will be permanently held in a fixed position. This means the joint will never bend again, but it often results in dramatic pain relief.

This article looks at arthrodesis as a treatment for severe arthritis. It also discusses recovery and some of the complications of this procedure.

Treatment for Arthritis

Arthrodesis can help treat advanced arthritis. Depending on the joint involved, it can be an alternative to joint replacement surgery.

Your healthcare provider may recommend this procedure if you are likely to have problems with a joint replacement. For example, younger, more active people may be more likely to wear out a new joint.

Before joint replacement surgery became common, arthrodesis was the standard surgery used to treat most types of severe arthritis. Today, joint replacement is much more common than it used to be, especially hip and knee replacement. This is why hip and knee fusions aren't often done.

Joint fusion is still common for other joints, however. For a few joints, it remains the preferred treatment. For example, arthrodesis is often used to treat some of the small joints of the hand and foot, because these joints can't be replaced.

Joint fusion for some other joints is controversial. For example, some surgeons think ankle replacement is a better option than ankle fusion and vice versa. Ultimately, the choice depends on the needs of the individual person. For example, joint replacement may be better for people who often walk up and down stairs or on uneven ground.

Complications of Arthrodesis

Arthrodesis can lead to increased wear on neighboring joints. This happens because the joints above and below the fusion have to do more work. This excess wear may lead to arthritis in adjacent joints.

Your surgeon will use metal plates and screws to help fuse the joint. In order for the surgery to be successful, however, the bone also needs to grow across the fused joint. When this doesn't happen, it's called nonunion.

Nonunions are especially common in smokers. This is why some surgeons won't attempt a fusion on someone who smokes. 

Other potential complications include infection (a possibility with any surgery) and malalignment, when the joint doesn't fuse correctly.

Recovering From Arthrodesis

Recovery from arthrodesis varies depending on which joint was fused. For example, after an ankle fusion, your foot will need to be immobilized for at least six weeks, and up to 12 weeks. You will also need to use crutches or a knee scooter while your ankle heals. It may be a few months before you can put your full weight on your ankle. 

Special shoes can help compensate for any stiffness in your ankle after surgery. You will also benefit from physical therapy to help you regain strength and balance and to help you learn to walk with a fused ankle.

Similarly, if your surgery was in your hand, the joint will need to be immobilized for a few weeks. For example, if you have thumb arthrodesis, you will need to wear a cast that extends to your elbow. This will help ensure the joint fuses properly.

After the cast is removed, you may need to wear a removable splint for an additional period of time. Physical therapy can help you regain strength and range of motion in the other joints in your hand.

It is important to understand that your joint will not bend afterward. Most people who have this type of surgery report significant improvement in pain and some improvement in function, but you should not expect a return to normal function after this type of surgery. 

Summary

Arthrodesis is a surgical procedure that fuses two bones together across a joint. It is used to treat pain caused by severe arthritis. After this procedure, most patients have a significant improvement in their pain, but the joint will no longer bend.

Arthrodesis is an alternative to joint replacement. It is less commonly used for hip and knee replacements. For some patients, especially those who are likely to wear out a new joint, it may be a better option than joint replacement. For joints that can't be replaced, like the small bones in the hand, arthrodesis may be the best treatment option.