Arthrodesis

Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery. This is done to relieve intractable pain in a joint which cannot be managed by pain medication, splints, or other normally indicated treatments. The typical causes of such pain are fractures which disrupt the joint, severe sprains, and arthritis. It is most commonly performed on joints in the spine, hand, ankle, and foot. Historically, knee and hip arthrodeses were also performed as pain-relieving procedures, but with the great successes achieved in hip and knee arthroplasty, arthrodesis of these large joints has fallen out of favour as a primary procedure, and now is only used as a procedure of last resort in some failed arthroplasties. Arthrodesis can be done in several ways: A bone graft can be created between the two bones using a bone from elsewhere in the person's body (autograft) or using donor bone (allograft) from a bone bank. Bone autograft is generally preferred by surgeons because, as well as eliminating the risks associated with allografts, bone autograft contains native bone-forming cells (osteoblasts), so the graft itself forms new bone (osteoinductive), as well as acting as a matrix or scaffold to new bone growing from the bones being bridged (osteoconductive). The main drawback of bone autograft is the limited supply available for harvest. Bone allograft has the advantage of being available in far larger quantities than autograft; however, during the treatment process the bone goes through following harvest, which usually involves deep-freezing and may also involve demineralization, irradiation and/or freeze-drying, kills living bone or bone marrow cells. This significantly reduces the immunogenicity (risk of graft rejection) such that no antirejection drugs are needed, and combined with appropriate donor screening practices, these processing and preservation practices can significantly reduce the risk of disease transmission.