26860 Arthrodesis, interphalangeal joint, with or without internal fixation

Name of the Procedure:

Arthrodesis, Interphalangeal Joint (IP Joint Fusion)

Summary

Arthrodesis of the interphalangeal joint is a surgical procedure to fuse the bones in the finger or toe joint. This may involve using metal hardware for stabilization. It’s designed to relieve pain and enhance stability by eliminating motion in the affected joint.

Purpose

Arthrodesis aims to alleviate chronic pain and instability in the interphalangeal joint, typically due to severe arthritis, deformities, or traumatic injury. The expected outcome is a more stable and pain-free joint, though it will no longer bend.

Indications

This procedure is indicated for patients experiencing severe joint pain, poor function, or deformity that has not improved with conservative treatments like medication, physical therapy, or splints. It’s suitable for individuals with advanced arthritis, traumatic joint injury, or severe deformities that significantly impact daily activities.

Preparation

Patients are usually instructed to fast for a specific period before the procedure. Medications, particularly blood thinners, might need adjustment as advised by the healthcare provider. Preoperative diagnostic tests may include bloodwork and imaging studies like X-rays or an MRI to assess the joint condition.

Procedure Description

1. Anesthesia: The patient receives regional or general anesthesia to ensure they are comfortable and pain-free during the procedure.
2. Incision: A surgical incision is made over the joint.
3. Joint Preparation: The damaged cartilage is removed to prepare the bone surfaces.
4. Alignment and Fixation: The bones are aligned in the optimal position and may be held together with metal screws, pins, or plates to facilitate fusion.
5. Closure: The incision is closed with sutures or staples, and a bandage is applied.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and the number of joints involved.

Setting

Arthrodesis of the interphalangeal joint is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon: Typically an orthopedic or hand surgeon.
• Anesthesiologist: Manages anesthesia during the procedure.
• Surgical Nurses and Technicians: Assist in the operating room.

Risks and Complications

• Infection: May require antibiotics.
• Nonunion or delayed union: Where the bones fail to fuse properly.
• Hardware issues: Potential for irritation or hardware breakage.
• Pain and swelling: Common post-operative symptoms.
• Nerve damage: Though rare, there is a risk of nerve injury leading to numbness or tingling.

Benefits

The primary benefit is pain relief in a previously painful joint, along with improved stability. Most patients experience these benefits shortly after recovery from surgery, although complete healing and pain resolution might take several weeks to months.

Recovery

• Post-Procedure Care: Includes keeping the surgical site clean and dry, wearing a splint or cast, and following prescribed physical therapy exercises.
• Recovery Time: Usually ranges from 6 to 12 weeks. Full fusion and return to normal activities might take longer.
• Restrictions: Patients are advised to avoid strenuous activities and to follow weight-bearing and movement restrictions as recommended by their surgeon.

Alternatives

• Conservative Treatments: Physical therapy, medications, or orthotic devices.
• Other Surgeries: Joint replacement or tendon repair.
• Pros and Cons: Non-surgical treatments may offer temporary relief without the risks of surgery, but they may not be as effective in severe cases. Joint replacement can preserve mobility but has its own risks and a different set of post-operative needs.

Patient Experience

Patients might experience discomfort and swelling post-procedure, managed with prescribed pain medications. Immediately after the surgery, there may be a period of immobilization, and physical therapy is often required to regain strength and function. With proper care, patients can expect significant pain relief and improved joint stability.