1. ARTHRODESIS PREPARED BY DR. DAWIT ALEMAYEHU 1

2.  Arthrodesis is fusion of the joints by surgical methods.  Arthrodesis (fusion) creates a bony union between bones of a diseased joint;  ankylosis (fibrous union) may retain some motion  it can be used in the following situations:  Gross destruction of the joints as in rheumatoid arthritis, Charcot’s joints or advanced osteoarthritis.  Quiescent tubercular arthritis.  Gross instability due to muscle paralysis as in polio.  For permanent correction of a deformity Prepared by Dr. Dawit Alemayehu 2

3. 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.  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 Prepared by Dr. Dawit Alemayehu 3

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5.  History of no motion at the joint, minimal if any pain, no pain with weight bearing in lower extremity fusions; usually a history of septic arthritis  Physical exam shows no motion at the joint area; nontender to palpation if fully healed  Radiographs show bridging of bone across the joint  Arthrodesis of the hip and knee can be converted to total joint arthroplasty, if infection is clearly resolved Prepared by Dr. Dawit Alemayehu 5

6.  The principles of arthrodesis are straightforward and involve four stages: 1. Exposure – both joint surfaces need to be well visualized and often this means an extensile incision, but some smaller joints are now accessible by arthroscopic means. 2. Preparation – both articular surfaces are denuded of cartilage and sometimes the subchondral bone is ‘feathered’ to increase the contact area. 3. Coaptation – the prepared surfaces are apposed in the optimum position, ensuring good contact. 4. Fixation – the surfaces are held rigidly by internal or external fixation. Sometimes bone grafts are added in the larger joints to promote osseous bridging. Prepared by Dr. Dawit Alemayehu 6

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8. Pearl  Arthrodesis is a treatment of last resort in patients with infection of the hip, knee, shoulder, or ankle;  shoulder arthrodesis is indicated in deltoid paralysis Prepared by Dr. Dawit Alemayehu 8

9. Reference  Text Book Of Orthopedics  Miller's Review of Orthopaedics 7th Ed  Apley 2017 Prepared by Dr. Dawit Alemayehu 9