Arthrodesis for Rheumatoid Arthritis

Overview

In cases of advanced rheumatoid arthritis (RA), joints may be destroyed or badly eroded. Medication or corrective surgery may no longer help. In these cases, arthrodesis, or joint fusion surgery, can relieve pain and stabilize the joint, making it better able to bear weight. Arthrodesis may also be referred to as artificial ankylosis or syndesis. In people with RA, arthrodesis is most frequently performed on wrists, ankles, spine, and fingers and thumbs. After receiving arthrodesis on a joint, you will no longer be able to bend or flex it.

Arthrodesis is not a cure for RA, and it does not prevent future disease activity.

What does it involve?
Your doctor may order a complete physical, blood tests, or other diagnostic procedures to ensure that you are in good condition for surgery.

Once your arthrodesis is scheduled, spend the weeks before surgery preparing by eating nutritious meals and staying as active as possible. Stop or cut down your smoking, and limit your consumption of alcoholic beverages to one or two per day. Being in top condition for surgery will shorten your recovery time and help prevent complications.

You will be given instructions to stop eating a few hours before surgery. When you arrive at the hospital, vital signs will be taken, and blood may be drawn. Before surgery, you will receive an intravenous (IV) line and general anesthesia to make you sleep.

The technique used during arthrodesis depends largely on which joint is being replaced. Arthrodesis may be performed either using a minimally invasive arthroscopic procedure, in which five or six small incisions are made, or with traditional open surgery. During arthrodesis, the cartilage will be cut away from the surfaces of the bones where they articulate together. The joint will then be fused using either donated or grafted bone, metal screws, plates, or wire, or a combination of these materials. At the end of surgery, the surgeon may place temporary drains at the surgical site before closing the incisions.

Depending on your condition and the surgical technique used, you may spend several nights in the hospital recovering from arthrodesis. The nurse or doctor will explain how to care for your wound. You may need to wear a cast or brace for several weeks after surgery while the bones heal and fuse together. Your surgeon will order regular x-rays to check that the healing process is going well. You may require physical therapy to learn how to adapt your movements or use adaptive shoes or other devices.

Intended Outcomes
Arthrodesis can reduce pain, stabilize joints, and improve the quality of life.

Results
Many people who have received arthrodesis surgery report a significant reduction in pain and high levels of satisfaction with the outcome.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

You will need to learn how to function with the fused joint. This may require undergoing physical therapy and learning how to use adaptive devices.

You may still have pain even after a successful arthrodesis surgery.

Blood vessels or nerves may be damaged during arthrodesis, resulting in weakness or numbness.

The fused bones may not heal together as planned (nonunion) after arthrodesis. The fused bones may heal incorrectly (malunion), causing pain and requiring further surgery. Grafted bone or hardware may fail or break after the surgery.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.