Arthrodesis Surgery in Delhi, India

Arthrodesis is best suited for candidates with the following:

• Damaged joints or articulations that connect the bones
• Chronic and severe pain in the joints or bone
• Limited mobility
• Joint degeneration with arthritis
• Inflammation of joints (pain, swelling, and redness)
• Deformity of the hands, thumbs, and knees
• Damage due to old age, trauma, congenital conditions, and other underlying conditions.
• Herniated disc (spine)
• Scoliosis and spine injuries, including a spine fracture

Arthrodesis is considered only when other treatment modalities have failed to improve patients' health. This therapy primarily focuses on relieving pain and correcting bone anomalies and deformities. The indications of arthrodesis are:

• Valgus foot deformities
• Collapsing Pes Plano Valgus deformity
• Advanced tibialis posterior tendon dysfunction
• Tarsal coalition
• Varus foot deformities that cannot be adequately braced
• Cavus and cavovarus
• Talipes equinovarus
• Rheumatoid arthritis (RA)
• Degenerative arthritis (e.g., degenerative joint disease [DJD])
• Post-traumatic arthritis
• Chronic pain
• Joint instability
• Neuromuscular disease
• Chronic severe Tuberculosis of joints (last resort)
• Mueller-Weiss disease

Contraindications for arthrodesis procedure include the following:

• Conditions that can be treated with external bracing, soft-tissue procedures, tendon balancing, or lesser fusions.
• Chronic smoking is a relative contraindication. It may lead to the nonunion of bones.

Tests and necessary preparations are discussed with the patient to ensure the success of the surgery. Some tests include:

• Physical examination
• Blood tests
• Imaging tests
• Patients who smoke are advised to quit since it interferes with healing.
• Patients taking medications like blood thinners are advised to stop taking them about a week before the procedure. It may prevent the chances of excessive bleeding.

Laboratory Studies

Except for standard preoperative studies, no specific laboratory tests are warranted if the pain is from degenerative joint disease. However, arthritis panels are ordered to eliminate inflammatory arthropathy or gout when the underlying diagnosis is not as precise. If Charcot arthropathy (painless destructed joints) is suspected, imaging studies or bone biopsies are advised. A joint-fluid analysis is performed if gout or infectious disease (such as Tuberculosis) is suspected. 

Imaging Studies

Standard x-rays may be advised to visualize the affected joint.

At the consultation before the surgery, one must inform the doctor about any ongoing medications and pre-existing medical conditions. A complete body scan helps assess undiagnosed conditions and prepare the treatment plan.

Medical Evaluation

The patient must be thoroughly examined before the surgical procedure. 

Medications

It is essential to inform the treating orthopaedic surgeon about ongoing medications since some medicines may interfere with the surgical procedure. Blood thinners must be stopped three days before the surgery and two days after to control the bleeding.

Other factors that one should consider are:

• Quit smoking to prevent surgical complications. Consumption of tobacco products should also be prohibited.
• Exercise well and maintain a healthy diet for a speedy recovery
• Twelve hours of fasting before the procedure is recommended to avoid complications from anaesthesia.

Usually, the conditions can be treated using non-surgical methods such as medications, rehabilitation, and pain injections. However, arthrodesis is considered only when the patient experiences excruciating pain that does not respond to all non-surgical treatments.

First, all cartilage is removed to bring the bones in direct contact. Then, the joint is fixed with metal wires, screws, external pins, and rods. This permits the joint to fuse in one particular position and heal. Additionally, it makes the bone immovable. 

The procedure is often indicated in areas that require the least range of motion. For instance, ankles are preferred over the knee or hip joints for arthrodesis.

Arthrodesis is generally a safe procedure and rarely leads to complications. However, if they occur, they are treatable. Some of them include:

• Malunion
• Nerve damage 
• Unhealing tissues and wound
• People who smoke carry an increased risk of pseudo-arthritis; in this condition, not enough bone forms for fusion. And hence, a second surgery may be needed to fix the condition.
• Breakage of metal implants
• Failure of the fusion site
• Painful scar tissue
• Arthritis in nearby joints
• Bleeding
• Blood clots
• Infection
• Continuing pain at the bone fusion site after surgery may also occur.

• Hospital discharge: In most cases, patients can return home within one or two days after the surgery.
• Pain management: After surgery, one must take pain medications as advised by the doctor. For instance, opioids, NSAIDs.
• Weight-bearing: Using crutches/walkers after the surgery helps one walk easily and conveniently. A knee brace or cast may be placed to limit the movement of the operated bones.
• Regular follow-ups are essential to assess how well the bones have healed.
• Rehabilitation exercises: During rehabilitation, a physical therapist guides with exercises to help maintain movement of the operated joint. Additionally, it helps restore strength.
• Normal activities can be resumed 3 to 6 months after surgery.
• Over time, the ends of the joint grow and unite to form a single unit.