Chapter 82 - Arthrodesis Techniques

Question 1

1. What is arthrodesis?

Answer 1

• A salvage procedure that is used for relief of pain associated with severe degenerative joint disease, stabilization of a limb after loss of supporting soft tissue structures, and/or treatment of complicated fractures involving a joint

Question 2

2. What is ankylosis?

Answer 2

• Fusion of bones of a joint damaged by disease or injury, or it may be achieved through a surgical procedure

Question 3

3. What is the most commonly used technique for facilitated ankylosis? (2)

Answer 3

• Mechanical removal of cartilage, can be achieved by drilling, with a curette, or motorized burr

Question 4

4. What other techniques are possible for facilitated ankylosis aside from cartilage removal? (3)

Answer 4

• Intra articular injection of chemical substances
• Direct application of laser or electrosurgical energy to cartilage
• A hydrothermal intraarticular lavage procedure

Question 5

5. What happens to 2 cancellous bone surfaces for most successful arthrodesis and facilitate fracture healing? (3)

Answer 5

• Aligned
• Compressed
• Stabilized

Question 6

6. Why should maximum bone contact be achieved in arthrodesis?

Answer 6

• Articular cartilage inhibits vascular invasion and ossification, as much should be removed as possible

Question 7

7. What is and what happens with osteostixis?

Answer 7

• Drilling several holes across the dense subchondral bone plate
• Promotes ingrowth of blood vessels and accelerates fusion

Question 8

8. What additive agent can improve bone fusion in arthrodesis?

Answer 8

• A cancellous bone graft or alternative osteoinductive material

Question 9

10. How is the joint immobility and compression best accomplished?

Answer 9

• Placing a combination of multiple transarticular screws in lag fashion and applying bone plates

Question 10

9. How should a cancellous bone graft be placed?

Answer 10

• Loosely packed, not squeezed, because this will mechanically damage viable cells

Question 11

11. What may improve postoperative comfort and minimize patient morbidity?

Answer 11

• Increased stability of the fixation