Arthrodesis
The arthrodesis ( altgriech. Ἄρθρον Arthron , joint 'and δέσις desis , binding') is a surgical joint stiffness . The ability to move in the joint is completely prevented. Either the joint is opened (intra-articular arthrodesis) or not opened (extra-articular or para-articular arthrodesis). If a fixation is only temporarily applied across a joint, e.g. B. with a K-wire , there is a temporary arthrodesis.
Arthrodesis on the spine is called a spinal fusion . The natural (disease-related) joint stiffening is called ankylosis .
Surgical joint stiffening is in principle possible on all joints. Hip and knee arthrodesis have become rare since the introduction of endoprostheses. The procedure is still performed relatively often on the shoulder, hand, ankle and ankle joints. Arthrodesis of the first tarsometatarsal joint (lapidus arthrodesis) is a common procedure for correcting a severe unstable hallux valgus, and the metatarsophalangeal joint arthrodesis of the big toe is often performed for hallux rigidus .
history
The term arthrodesis was introduced by Eduard Albert . In 1878 he performed the first arthrodesis in a girl with polio and achieved stable knees. In 1887 he performed the first successful hip arthrodesis. The first report of a successful hip joint arthrodesis from the French-speaking area comes from Lagrane in 1886 , and from the English by F. Albee in 1908.
Indications
Arthrodesis is performed, for example, in severe osteoarthritis , in chronic joint instability due to paralysis, or to correct a severe deformity (e.g. hallux valgus ). In the case of osteoarthritis, arthrodesis is an alternative to joint prosthesis and resection-interposition arthroplasty.
Arthrodesis can also be used for flaccid paralysis, e.g. B. after poliomyelitis , usually in the ankle area in order to achieve sufficient stability.
In patients with tetraplegia, arthrodesis in the wrist area together with tendon transfers are used to prevent finger movements and v. a. restore a gripping function with the help of redirected, non-paralyzed muscles.
Arthrodesis are occasionally an option for joints that have been destroyed by purulent arthritis or osteomyelitis near the joint .
execution
The open arthrodesis procedure involves resection of the cartilaginous parts of the joint, often with removal of the underlying bone, which can also be used to correct the axis. This is usually followed by internal fixation with an osteosynthesis . Cannulated (hollow) screws (as in the picture of the shoulder arthrodesis), K-wires, intramedullary nails or plates can be used. This depends on the location of the arthrodesis, the surgeon's preference, and the specific indication. To improve bone healing, your own bone graft (iliac crest cancellous bone ) or artificial bone substitute materials can also be attached. After the operation, it is usually necessary to rest for several weeks in a plaster cast or splint so that the former joint can develop.
Complications
The consequence of the stiffening is a partial or complete assumption of mobility by neighboring joints, which can also be damaged in the medium-term. The decision on arthrodesis should therefore always take into account the condition of the neighboring joints. The loss of function with arthrodesis in the foot and ankle joint area can be compensated very well and sometimes requires a sole adjustment (sole roll), insoles, shoe adjustments or orthopedic custom-made shoes. In the case of post-traumatic (and post-infectious) instabilities, arthrodesis can mean a significant gain in functionality.
A lack of osseous development of the arthrodesis ( pseudarthrosis ) is almost always the result of insufficient pressure on the joined ends of the bones.
literature
- KD Thomann: The artificial joint stiffening. On the history of a therapeutic procedure. In: Th. Stuhler (Ed.): Arthrodesis (Congress report). Berlin / Heidelberg / New York 1991.
Web links
Individual evidence
- ↑ Georg Hohmann: Foot and Leg. Your diseases and their treatment. Springer, Heidelberg 1948, ISBN 978-3-642-49618-9 , pp. 400-401.
- ↑ G. Zeiler, A. Schuh: The arthrodesis of the hip joint and its remobilization. In: The orthopedist. 33, 2004, p. 490, doi : 10.1007 / s00132-004-0697-1 .
