Introduction

Arthrodesis, commonly known as joint fusion surgery, is a surgical procedure aimed at permanently joining the bones of a joint. This is done to eliminate painful movement and create a stable, functional structure in joints that have been severely damaged or degenerated. Arthrodesis is most often used in joints that are no longer responsive to conservative treatments, such as pain medication, physical therapy, or less invasive surgical options. The goal of the surgery is not to preserve motion, but to create a pain-free joint that can bear weight or perform essential tasks.

This procedure is commonly performed on the spine, ankle, wrist, thumb, and certain small joints in the hand and foot. While the idea of losing movement in a joint might seem daunting, arthrodesis offers patients the opportunity to regain functionality by removing the source of chronic discomfort. It is a surgical solution designed for individuals whose joints are more of a liability than an asset due to instability, deformity, or degeneration. The procedure can be life-changing for many people, helping them walk, work, or perform everyday activities without the hindrance of severe joint pain.

Let’s explore the step-by-step arthrodesis surgery procedure is typically performed, from preparation through recovery.

Arthrodesis Surgery Procedure

Preoperative Preparation :- Before arthrodesis can be performed, a comprehensive evaluation is done to confirm that joint fusion is the most suitable option. This involves a combination of physical examinations, imaging studies like X-rays or CT scans, and discussions about symptoms, activity level, and prior treatments. Surgeons will assess joint damage, bone quality, alignment, and the presence of any infection or inflammation that could affect healing. Once the decision is made to proceed with arthrodesis, patients undergo preoperative tests to check their overall health. These may include blood tests, ECGs, and sometimes pulmonary evaluations, especially for those with chronic conditions. The patient will be advised to stop certain medications that can affect bleeding or healing. Smokers may be required to quit, as smoking significantly delays bone fusion. Patients also receive detailed instructions regarding fasting before surgery, what to bring to the hospital, and what to expect postoperatively. In some cases, a temporary cast or brace may be applied preoperatively to simulate joint immobility and ensure the patient will tolerate the loss of motion.
Anesthesia and Positioning :- The procedure typically takes place in a hospital or surgical center under sterile conditions. The choice of anesthesia depends on the joint being fused, the patient’s health, and surgeon preference. General anesthesia is common for major joints like the spine or ankle, while regional blocks may be used for wrist or finger fusions. The patient is carefully positioned to give the surgical team optimal access to the joint. This positioning is crucial, especially in spinal or lower limb fusions, where improper alignment can lead to long-term complications. The area is then cleaned thoroughly with antiseptic solution, and sterile drapes are applied. Once anesthesia takes effect and proper positioning is ensured, the surgeon begins the process of accessing the joint. This may be done through an open incision or, in certain joints like the spine, using minimally invasive techniques.
Joint Preparation and Fusion :- The core of arthrodesis surgery involves preparing the joint surfaces and creating a stable environment for bone fusion. First, the surgeon removes the damaged cartilage from the ends of the bones. This is essential, as cartilage cannot fuse only raw bone surfaces can heal together. Any inflammatory or diseased tissue is also cleared out. Once the bone surfaces are exposed, they may be shaped or repositioned to achieve the optimal angle and alignment for fusion. In some cases, bone grafting is needed. Bone grafts can be taken from the patient’s own body (autograft), such as from the pelvis, or from a donor (allograft). The graft helps bridge gaps between the bones and promotes healing. Next, the bones are held in place using internal fixation devices like screws, plates, rods, or wires. These provide mechanical stability and ensure that the bones remain in proper alignment throughout the healing process. In certain cases, external fixators devices outside the skin connected by pins into the bone may be used. During spinal arthrodesis, bone grafts are often combined with interbody cages or spacers to maintain disc height and promote fusion between vertebrae. The spine may also be stabilized with rods and screws inserted into the vertebrae to provide rigid support. Once everything is in place, the surgical site is irrigated to reduce infection risk, and layers of tissue are carefully closed. A sterile dressing is applied, and the joint is immobilized using a cast, splint, or brace depending on the location and complexity of the procedure.
Postoperative Recovery and Rehabilitation :- After surgery, patients are taken to a recovery room where they are monitored as the anesthesia wears off. Pain is managed using medications, and vital signs are carefully observed. Depending on the joint and the patient’s overall condition, hospitalization may last from one day to several days. The healing period following arthrodesis is significant, as it takes time for bones to fully fuse. During the first few weeks, strict immobilization is often required. Weight-bearing is typically restricted or limited in lower limb surgeries until early signs of fusion are evident on X-rays. In upper limb fusions, patients may need to avoid lifting or using the hand for several weeks. Physical therapy begins gradually. Initially, therapy focuses on maintaining strength and flexibility in surrounding joints and muscles. As healing progresses, therapists work with the patient to retrain movements, gait, or body mechanics that accommodate the fused joint. This is especially important in ankle, spine, or hand fusions, where biomechanics change post-surgery. Routine follow-up visits are essential to monitor bone healing through imaging. The time it takes for complete fusion varies usually between 6 weeks and 6 months depending on factors like bone health, surgical site, smoking status, and adherence to postoperative instructions.
Long-Term Outcomes :- When successful, arthrodesis provides excellent long-term relief from pain and improves functional stability in the affected joint. Patients typically report reduced reliance on pain medications, better sleep, and the ability to return to work or hobbies previously limited by pain. Although mobility is reduced in the fused joint, most patients adapt well over time and experience minimal limitations in their daily lives. For example, someone who has undergone ankle fusion may not be able to jog, but can walk, stand, and perform regular tasks without discomfort. Similarly, spinal fusion may reduce certain movements but restore posture, eliminate nerve pain, and improve quality of life. Patients are often advised to avoid high-impact activities or overloading the joint post-fusion. Proper footwear, bracing, or ergonomic adjustments may be needed to support surrounding joints and prevent future complications.

Conclusion

Arthrodesis surgery is a well-established and highly effective procedure for patients suffering from chronic joint pain, deformity, or instability that does not respond to conservative treatment. While it comes with the trade-off of reduced mobility, it offers substantial gains in terms of pain relief, function, and quality of life. The procedure involves a careful process of preparation, joint cleaning, fixation, and rehabilitation, all aimed at achieving a successful bone fusion.

Choosing arthrodesis is a significant decision that should be made with a clear understanding of the benefits and limitations. With modern surgical techniques, strong fixation methods, and personalized rehabilitation plans, most patients achieve satisfying long-term outcomes that help them reclaim their independence and daily function.