All about Joint Fusion Surgery or Arthrodesis

When the pain from arthritis incapacitates the patient and when all the other treatment modalities to handle arthritic pain do not yield results, your orthopedic doctor will suggest joint fusion surgery or arthrodesis.

Understanding Arthritis

Arthritis is a condition affecting joints which causes pain and inflammation and makes the joints less flexible. There are two common types of arthritis:

• Osteoarthritis
• Rheumatoid arthritis

In osteoarthritis, the cartilage that covers the ends of bones gets worn away. As a result, the bones rub against each other leading to pain. With time, the bones themselves might deform.

Rheumatoid arthritis is an autoimmune disease in which the person’s own immune mechanism acts against the joints leading to pain.

The treatment rendered depends on the type of arthritis affecting the patient. Non-invasive treatment methods will first be tried. The goal of all treatment modalities will be to reduce pain, improve quality of life and preserve mobility.

Treatment options include:

• Medication to deal with the pain
• Physical therapy to promote mobility and bolster supporting muscles
• Maintaining weight to reduce pressure on the joints
• Surgeries are suggested only as the last option – joint repair surgery, joint replacement surgery or joint fusion surgery

What Is Joint Fusion Surgery or Arthrodesis?

• In simple terms, the procedure involves fusing together the two bone ends of the affected joint into one single bone.
• This will help reduce the pain experienced and will also promote joint stability and increase the weight bearing capacity of the joint.
• It is typically done for the smaller joints of the body.

The Procedure

• The procedure usually requires hospitalization the duration of which differs according to the patient’s recovery.
• Done under anesthesia, the surgeon will discuss the best form of anesthesia after talking to the patient.
• Once the anesthesia has taken effect, a cut will be made in the area of the affected joint.
• The damaged cartilage will first be removed through the cut.
• The two ends of the bones will then be fused together.
• To promote bone fusion, the surgeon might take a bone graft from the patient’s body and place it at the surgical site.
• In some cases, a prosthetic might also be used instead of a bone graft.
• The bones will then be held in place with plates, screw, etc.
• These plates, screws and any other hardware used will not be removed even later on.
• Once the bones a reset in place, the incision will be closed with sutures.

Factors to Consider

• Recovery after surgery takes time. The patient will need help around the house for at least 3 months after surgery. It is best to have it arranged ahead.
• Complete recovery might take up to a year in some cases.
• Though the surgery will reduce the pain experienced, mobility at the operated joint will be lost.
• After surgery, a cast or brace will be placed to allow the bones to set and heal.
• Weight should not be applied at the joint so depending on the joint operated on, walking support/wheelchair may be required initially.
• Pain after surgery is expected; the doctor will help with pain management.

Who Are Candidates for Arthrodesis?

• Arthrodesis will be suggested for those whose arthritic pain is so bad that it interferes with normal life.
• These are typically people for whom all the other modalities of treatment did not give relief.
• The pain relief after arthrodesis will be so significant that the reduction in mobility due to the fusion of joints will not be considered a drawback.
• Other than this, the overall health of the patient will also be considered by the doctor before an arthrodesis procedure is decided on.
• The extent of bone deformation due to arthritis is another factor that will decide the viability of the procedure.

Risks of Surgery

Any surgical procedure involves risks and arthrodesis is no different.

• After a joint fusion procedure, the nearby bones and muscles will try to compensate for the operated bone. This will lead to increased stress on those bones and might make them prone to arthritis.
• In some cases, the fusion of joints might not happen as expected. The condition is called a non-union and is more common in smokers. For this reason, doctors might not suggest joint fusion surgery for those who smoke.
• An infection which is a possibility with any surgery can happen with arthrodesis too.

Stalling Arthritis Advancement

Aging and osteoarthritis need not go hand in hand. There are a number of measures we can take up to avoid arthritis, of if already afflicted with it, to slow down its advancement.

• Weight Control: Increase in weight translates to an increase in the stress on the joints, especially the knees and hips. If weight is not kept under control, the cartilage at the joints and subsequently the bones themselves will start to degrade.
• Diabetes: Increased sugar levels affect the cartilage and promote their degradation. Keeping an eye on sugar levels is important to avoid/control arthritis.
• Physical Activity: Regular physical activity strengthens joints and prevents osteoarthritis. Setting aside just half an hour 5 days in a week to exercise will be the biggest gift we can give our body.
• Having a Healthy Lifestyle: Eating nutritious food, sleeping enough, exercising and quitting smoking and alcohol will all contribute greatly to our fight against osteoarthritis.