Complications in Arthrodesis Surgery

Introduction

Arthrodesis, or joint fusion surgery, is a widely used orthopedic procedure designed to treat severe joint pain and instability by permanently joining two or more bones in a joint. By eliminating movement, the procedure often alleviates pain caused by arthritis, trauma, deformity, or failed joint replacement. While arthrodesis has helped many patients achieve pain relief and regain functional mobility, it is a complex procedure that comes with inherent surgical risks and potential complications.

These complications can range from minor issues that resolve over time to more serious problems that may require additional surgery or long-term medical management. Every surgical intervention carries some degree of risk, and arthrodesis is no exception. Understanding the possible complications can help patients make informed decisions, set realistic expectations, and work proactively with their surgical team to ensure optimal outcomes.

Whether the procedure is performed on the spine, ankle, wrist, or any other joint, knowledge of the risks involved is crucial for both patients and healthcare providers. Let’s examine the most common and significant complications in arthrodesis surgery.

Complications in Arthrodesis Surgery

1. Nonunion or Delayed Union :- One of the most common and concerning complications following arthrodesis is nonunion, which occurs when the bones fail to fuse as intended. For successful joint fusion, the bone ends must grow together and form a solid, continuous structure. When this healing process is incomplete or too slow, it results in delayed union or nonunion. Several factors contribute to poor bone healing, including smoking, diabetes, poor nutrition, inadequate immobilization, infection, or excessive motion at the fusion site. Inadequate surgical technique or poor bone quality can also be contributing factors. Patients with nonunion often continue to experience pain and instability long after surgery. This complication may require revision surgery, the use of bone stimulators, or additional bone grafting to encourage healing. In some cases, multiple surgeries are needed before fusion is achieved.
2. Infection :- Infection is a potential complication in any surgical procedure, and arthrodesis is no exception. Postoperative infection can range from superficial skin infections to deep infections involving bone and soft tissues. The risk of infection is generally higher in cases involving open fractures, long surgical times, or patients with comorbidities like diabetes or obesity. Symptoms of infection may include increased redness, swelling, warmth, pain, fever, or drainage from the surgical site. Infections must be treated promptly with antibiotics, and in severe cases, surgical debridement or removal of hardware may be required. Chronic infections, particularly in joints like the ankle or spine, can be extremely difficult to eradicate and may compromise the success of the fusion. Infected arthrodesis sites may eventually require removal of implants or even amputation in extreme cases, especially if bone necrosis or sepsis occurs.
3. Hardware Complications :- Internal fixation devices such as screws, rods, plates, or wires are often used during arthrodesis to maintain proper alignment and stability while the bones fuse. However, these devices can sometimes lead to complications, particularly if they become loose, break, or migrate from their original position. Hardware failure can cause pain, irritation, nerve damage, or renewed instability at the fusion site. In some instances, patients may feel the hardware through the skin, especially in areas with minimal soft tissue coverage, like the wrist or ankle. If the implants cause discomfort or interfere with healing, a secondary surgery may be necessary to adjust or remove the hardware. In rare cases, hardware issues may contribute to nonunion or require a complete revision of the fusion procedure.
4. Loss of Adjacent Joint Function :- While arthrodesis effectively stabilizes the targeted joint, it alters the biomechanics of the surrounding joints. When one joint is fused and no longer moves, neighboring joints often take on additional stress to compensate for the lost motion. Over time, this can lead to increased wear and tear, inflammation, and even degenerative arthritis in adjacent joints. For example, after ankle fusion, increased strain may fall on the subtalar or midfoot joints. Similarly, spinal fusion can result in adjacent segment disease, where vertebrae above or below the fusion site begin to break down. This complication can emerge months or even years after the initial surgery and may lead to new pain, reduced function, and, in some cases, the need for further surgery to address the adjacent joint deterioration.
5. Nerve Injury :- Nerves located near the surgical site can be at risk during arthrodesis procedures. These nerves may be stretched, compressed, or accidentally injured during surgery, leading to complications such as numbness, tingling, burning sensations, or weakness in the affected area. Nerve injuries are more common in complex fusions, such as spinal fusion or ankle fusions, where major nerves run close to the surgical field. While many nerve injuries are temporary and resolve with time, others may result in lasting neuropathy. In some cases, nerve damage can significantly affect mobility, sensation, or quality of life. Postoperative treatments may include physical therapy, medications for neuropathic pain, or additional surgical interventions to decompress or repair the damaged nerve.
6. Reduced Range of Motion :- By its very nature, arthrodesis eliminates movement in the affected joint. While this is often a necessary trade-off to relieve pain and instability, it can lead to long-term limitations in mobility, particularly in joints that play a significant role in complex movements, such as the ankle, wrist, or spine. Patients may experience difficulty performing certain tasks, compensatory movements in other parts of the body, or limitations in athletic or occupational activities. Over time, these changes can affect posture, gait, or overall physical function. In some individuals, the functional limitations imposed by fusion are more significant than expected, particularly if the surrounding joints are already arthritic or damaged. While many people adapt well with therapy and support, others may struggle with the permanent loss of motion and altered biomechanics.
7. Blood Clots :- Though relatively uncommon, the risk of developing deep vein thrombosis (DVT) or pulmonary embolism (PE) exists after any major orthopedic surgery, especially those involving the lower extremities. Prolonged immobility, general anesthesia, and certain underlying health conditions can increase this risk. Clots can form in the legs and travel to the lungs, causing life-threatening complications. Preventive measures include early mobilization, use of blood thinners, compression stockings, and leg exercises. Patients should be educated about the signs of DVT such as swelling, redness, and calf pain and pulmonary embolism symptoms like shortness of breath and chest pain, and instructed to seek medical attention promptly if these occur.

Conclusion

Arthrodesis surgery offers significant relief for many individuals suffering from severe joint pain, instability, or deformity. It can restore function, improve stability, and reduce dependency on medications and assistive devices. However, like all surgical procedures, it is not without risks. Complications such as nonunion, infection, nerve injury, and hardware failure can impact the success of the surgery and the patient’s overall quality of life.

Understanding the potential risks involved in arthrodesis allows patients to make well-informed decisions and encourages proactive measures that can reduce the likelihood of complications. With proper patient selection, careful surgical technique, and attentive postoperative care, the chances of a successful and complication-free outcome are significantly increased.

Patients considering arthrodesis should work closely with their orthopedic surgeon to weigh the risks and benefits based on their unique health status, lifestyle needs, and long-term goals. While complications are a possibility, so too is the opportunity for life-changing relief and improved daily function.