Principles of Arthrodesis

Introduction

Most reliable operation for pain or instability where stiffness does not seriously affect function, e.g. spine, tarsus, ankle, wrist, & inter-phalangeal joints.

Arthrodesis may be

  • Intra-articular
  • Intra-articular & extra-articular
  • Extra-articular

Choice will depend on patients age, pathologic process & presence or absence of gross deformity.

Principles

  • Exposure
    • Good exposure whilst care not to over devascularise bone
  • Preparation
    • Denude joints
    • feather subchondral bone
    • add bone graft in larger joints
  • Coaptation
    • Surfaces are apposed in optimal position
  • Fixation
    • surfaces held rigidly
    • protect until union
  • Main complication is pseudarthrosis

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