Describe Arthrodesis & Arthroplasty in detail.
Two Reconstructive Options
When a joint is irreparably damaged, two contrasting surgical solutions exist: arthrodesis (surgical fusion of the joint) and arthroplasty (reconstruction or replacement to preserve movement). The choice depends on the joint, the patient’s age and demands, and the state of the surrounding tissues.
| Arthrodesis (fusion) | Arthroplasty (replacement) | |
|---|---|---|
| Aim | Painless, stable, stiff joint | Painless, mobile joint |
| Movement | Abolished | Preserved |
| Durability | Very durable, no implant wear | Wears/loosens; may need revision |
| Best for | Young, heavy-demand; single joint; unstable/infected | Older; hip/knee; multiple-joint disease |
Considerations
Arthrodesis gives a strong, durable, painless joint well suited to a young labourer or a joint that is unstable, infected or paralysed, but at the cost of movement and with increased load on adjacent joints. Arthroplasty preserves motion and is ideal for the hip and knee and for older, lower-demand patients or those with multiple affected joints (e.g. Rheumatoid disease, where fusing several joints would be crippling), but is limited by wear, loosening and infection.
CLINICAL PEARL
A helpful rule of thumb: fuse the joint of a young manual worker (durable, pain-free strength) and replace the joint of an older, lower-demand patient (preserves the movement they need) — individualised to the joint and patient.
Other Options & Modern Practice
Between these two extremes lie osteotomy (realigning bone to offload a damaged compartment and preserve the native joint, useful in the younger patient with focal disease) and excision or interposition arthroplasty for certain small joints. Modern joint-replacement results are so good for the hip and knee that arthrodesis of these joints is now uncommon, reserved mainly for failed, infected or otherwise unreconstructable situations; fusion remains valuable for the ankle, wrist and small joints of the hand and foot.
CLINICAL PEARL
Think of it as a trade-off: arthrodesis exchanges movement for durable, pain-free strength, whereas arthroplasty preserves movement at the cost of long-term wear — the right answer depends on which the particular patient and joint need most.
Arthrodesis trades movement for stability and durability.
KEY POINT
Key points TO remember
- Arthrodesis = fusion (stiff but strong/durable); arthroplasty = replacement (mobile but wears).
- Arthrodesis suits young, heavy-demand, unstable/infected/paralytic single joints.
- Arthroplasty suits older/lower-demand, hip/knee, and multi-joint (e.g. RA) disease.
- Choice individualised to joint, age, demand and soft tissues.
EXAM TIP
Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.
All questions in Arthritis & Joint Disorders
- Q1Define Osteoarthritis. Describe its clinical features, investigations, management and complications. ★
- Q2Define Rheumatoid Arthritis. Describe its clinical features, investigations, management and complications. ★
- Q3Define Avascular Necrosis of the Femoral Head. Describe its causes, clinical features, management and complications. ★
- Q4Joint Replacement ★
- Q5Define Ankylosing Spondylitis. Describe its clinical features, investigations, management and complications. ★
- SN1Define Gout & Pseudogout. Describe its clinical features and management. ★
- SN2Define Rheumatoid Hand Deformities. Describe its management and treatment.
- SN3Define Charcot (Neuropathic) Joint. Describe its causes and investigations.
- SN4Write a short note on Osteoarthritis vs Rheumatoid Arthritis. ★
- SN5Frozen Shoulder
- SN6Define Haemophilic Arthropathy. Describe its management and investigations.
- SN7Describe Arthrodesis & Arthroplasty in detail.