Arthrodesis

Arthrodesis
Arthrodesis is fusion of the joints by surgical
methods. Because it limits the function of the joint,
arthroplasty it is more commonly used nowadays.
However, it can be used in the following situations:
• Gross destruction of the joints as in rheumatoid
arthrititis, Charcot’s joints or advanced osteoarthritis.
• Quiescent tubercular arthritis.
• Gross instability due to muscle paralysis as in
polio.
• For permanent correction of a deformity.
Methods
There are three methods:
Intra-articular Arthrodesis
Here joint is opened, articular cartilage is denuded,
cancellous bone grafts are packed, joint is kept in a
functional position and either fixed internally or
externally by plaster, etc. .
Figs 28.10A and B: Different types of osteotomies:
(A) McMurray’s displacement osteotomy, (B) Angulation
osteotomy
.Charnley’s
compression arthrodesis.High tibial osteotomy
done in OA knee
370 Nontraumatic Orthopedic Disorders
Extra-articular Arthrodesis
This is indicated in infective condition of the hip,
shoulder or spine. In this, there is no risk of
reactivating or spreading the infection as the joint
itself is not opened, but bone-to-bone fusion is
obtained above or below the joint.
Combined Arthrodesis
This is a combination of the above two procedures.
Note: Arthrodesis of a joint gives it stability but takes away its
mobility. It is like robbing Peter to pay Paul.
Practical facts: Arthrodesis
Each joint should be fixed in its functional position as
mentioned below to enable the patient to continue using
it:
Joints Functional positions
Upper limbs
Shoulder 30° Abd/30° flexion/40°
internal rotation
Elbow
• Eating hand (right) 90° of flexion
• Toilet hand (left) 70° of flexion
Wrist 20° dorsiflexion
Forearm 10° pronation
MP joint 35° flexion
IP joints 45° flexion
Lower limbs
Hip 15° flexion, no adduction or
abduction or rotation
Knee 20° flexion
Ankle (men) 90° or neutral position
• Ankle (women) 15–20° of plantar flexion
Metatarsophalangeal Slight extension
Joints of big toe
Arthroplasty
Arthroplasty is an operation to construct a new
mobile joint. The following are the indications:
• Advanced osteoarthritis or rheumatoid arthritis
of hip, knee, shoulder, elbow, hand and foot.
• Quiescent destructive tuberculous arthritis of hip
and elbow.
• Fracture neck nonunion in patients of more than
60 years.
• Rarely to correct deformity, e.g. hallux valgus