26862 Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)

Name of the Procedure:

Arthrodesis, Interphalangeal Joint (IPJ) Fusion with or without Internal Fixation; with Autograft

Summary

Arthrodesis of the interphalangeal joint is a surgical procedure where the bones in the joint are fused together to eliminate pain and prevent instability. An autograft, bone tissue taken from the patient’s own body, is often used to facilitate the fusion.

Purpose

Arthrodesis is used to treat severe arthritis, deformities, or injuries in the interphalangeal joints (fingers or toes) that cause significant pain and disability. The goal is to stabilize the joint, alleviate pain, and improve function.

Indications

• Severe osteoarthritis or rheumatoid arthritis in the interphalangeal joints
• Joint instability or deformity
• Failure of conservative treatments like medications or physical therapy
• Impaired function causing difficulty in daily activities

Preparation

• Fasting may be required if general anesthesia is used.
• Medication adjustments might be necessary.
• Preoperative imaging studies like X-rays or MRIs are often performed.
• Pre-surgical assessments to evaluate overall health status.

Procedure Description

1. The patient is placed under regional or general anesthesia.
2. An incision is made over the affected joint.
3. The damaged cartilage is removed from the joint surfaces.
4. An autograft, often taken from the patient’s pelvic bone or another site, is shaped to fit the joint.
5. The graft is positioned between the bone ends, and internal fixation (e.g., screws, plates) may be used to stabilize the joint.
6. The incision is closed with sutures or staples.
7. The operated area is bandaged and immobilized.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Performed in a hospital or surgical center under sterile conditions.

Personnel

• Orthopedic surgeon or hand/foot specialist surgeon
• Anesthesiologist
• Surgical nurses
• Radiology technician (if imaging is needed during surgery)

Risks and Complications

• Infection
• Nerve damage
• Blood clots
• Nonunion or delayed union of the bone
• Pain or stiffness
• Complications related to anesthesia

Benefits

• Pain relief in the affected joint
• Improved joint stability
• Enhanced function and ability to perform daily activities
• Long-term solution to chronic joint issues

Recovery

• Immobilization of the joint via splint or cast for several weeks.
• Pain management with medications.
• Physical therapy may be recommended post-immobilization.
• Full recovery might take several months, with restrictions on certain activities.
• Follow-up appointments to monitor healing progress.

Alternatives

• Non-surgical treatments like physical therapy, medications, and orthotics.
• Joint replacement surgery may be an option in some cases.
• Pros of alternatives: Less invasive, shorter recovery time.
• Cons: May not provide lasting relief, may not be effective in severe cases.

Patient Experience

• During the procedure: The patient will be under anesthesia and should not feel pain.
• After the procedure: Expected discomfort and swelling managed by pain medications.
• Rehabilitation: Physical therapy might be necessary.
• Emotional support and assurance from the healthcare team can help with anxiety related to surgery and recovery.