26861 Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (List separately in addition to code for primary procedure)

Name of the Procedure:

Arthrodesis, Interphalangeal Joint

• Common names: Joint fusion surgery
• Technical terms: Arthrodesis, interphalangeal joint fusion

Summary

Arthrodesis of the interphalangeal joint is a surgical procedure designed to fuse the small joints in the fingers or toes, facilitating the painless movement by eliminating the joint mobility. This procedure may involve the use of internal fixation, such as screws or pins, to stabilize the bones.

Purpose

• Medical Conditions Addressed: Arthritis, joint instability, deformities, chronic pain
• Goals/Expected Outcomes: The primary goal is to relieve chronic pain, improve joint stability, correct deformities, and restore a functional alignment to the affected digit.

Indications

• Symptoms such as chronic pain, instability, or deformity in the interphalangeal joints unresponsive to conservative treatments.
• Specific conditions like severe osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis.
• Patients who have not benefited from other conservative treatments such as medication, physical therapy, or orthotics.

Preparation

• Pre-procedure instructions usually include fasting for several hours before the surgery, particularly if general anesthesia will be used.
• Medication adjustments, such as discontinuing blood thinners, may be necessary.
• Diagnostic tests may include X-rays or MRI scans to assess the joint condition and aid surgical planning.

Procedure Description

1. Anesthesia: Local, regional, or general anesthesia will be administered to prevent pain during the surgery.
2. Incision: A small incision is made over the affected interphalangeal joint.
3. Joint Preparation: The surgeon removes the cartilage from the joint surfaces to create a stable bone-on-bone contact.
4. Internal Fixation: Pins, screws, or plates may be used to hold the bones in the correct position to facilitate fusion.
5. Closure: The incision is closed with sutures or staples, and the area is bandaged.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and the number of joints being fused.

Setting

Performed in a hospital or surgical center, usually requiring a same-day or short overnight stay.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist
• Surgical nurses
• Support staff

Risks and Complications

• Common Risks: Infection, bleeding, swelling, stiffness
• Rare Risks: Nerve or blood vessel damage, nonunion (failure of the bones to fuse), or malunion (bones fuse incorrectly)
• Management: Antibiotics for infection, pain management, additional surgery if necessary for complications

Benefits

• Expected benefits include significant pain relief, improved joint stability, and corrected deformities.
• Benefits can generally be realized within a few weeks as the bones start to fuse and heal, but full results may take several months.

Recovery

• Post-procedure care includes keeping the surgical area clean and dry, using prescribed pain medications, and following up with regular medical check-ups.
• Physical therapy may be recommended to maintain flexibility in the surrounding joints.
• Recovery time varies but is typically around 6 to 12 weeks. Patients may need to limit physical activities to allow proper healing.

Alternatives

• Other treatment options include conservative measures like physical therapy, medication, or orthotic devices.
• Surgical alternatives might include joint replacement or joint debridement, though these are dependent on the specific condition of the patient.
• Each alternative has its own pros and cons, including less invasive nature for conservative treatments but possibly less permanent results compared to arthrodesis.

Patient Experience

• During the procedure, patients will be under anesthesia and will not feel pain.
• After surgery, there can be discomfort and tightness around the site, managed by prescribed painkillers.
• Patients may experience limited mobility in the fused joint but should be relieved from the chronic pain once healing progresses.
• A structured recovery plan, including physical therapy and regular medical follow-ups, will support optimal recovery and functionality.