Arthrodeses

Arthrodeses, or joint fusions, are surgical procedures that permanently immobilize a joint by promoting bone growth across the articulating surfaces. The goal is to eliminate joint motion, relieve pain, and provide stability when the joint is unsalvageable or when other treatments, such as joint replacement, are unsuitable. The procedure typically involves removing cartilage, preparing opposing bone surfaces, placing a bone graft to bridge the gap, and using internal or external fixation to compress the joint and support fusion during healing.

Indications for arthrodesis include end-stage degenerative joint disease where arthroplasty is not feasible or would have limited durability, severe inflammatory or post-traumatic arthritis, joint instability, certain infections or tumors requiring resection, and salvage after failed arthroplasty. It is also used in pediatric cases or in surveillance of neuropathic joints where motion is undesirable or risky.

Techniques vary by joint and include internal fixation with plates and screws, intramedullary nails, or external fixators. The aim is to achieve stable, alignment-conscious fusion with adequate contact between bone surfaces. Autograft, often from the iliac crest, is commonly used, with allograft or synthetic substitutes as alternatives. Alignment, limb length, and adjacent joint biomechanics are important considerations to minimize functional loss and secondary problems.

Common sites include the ankle (tibiotalar fusion), the foot (subtalar or tarsal-fusion), the knee, the hip, and the wrist. Outcomes typically include reliable pain relief and a stable platform, at the expense of motion at the fused joint. Complications can include nonunion or malunion, infection, hardware failure, and progression of degenerative changes in adjacent joints. Recovery involves immobilization, staged weight bearing, and rehabilitation.