Houston Orthopedic Surgery

Arthrodesis is the process of fusing bones together - usually in the case of a failing joint with chronic instability and pain. It allows bones that make up the joint to grow together, or fuse, into one solid bone.

The procedure is an alternative to complete joint replacement or arthroplasty and is often used in conditions of the wrist. While it is effective in eliminating pain associated with painful degenerative conditions, it limits range of motion.

The goal of arthrodesis is to limit motion by obtaining bony consolidation of worn joint surfaces and eliminate the pain generated when articular surfaces lose their cartilage covering and bone is allowed to rub directly against bone within a joint.

Both total and limited wrist arthrodesis are very important for an array of conditions affecting the wrist joint. Both were initially developed to decrease the pain of wrist joint arthritis and required periods of immobilization, in order to ensure healing and adequate fusion. Eventually internal fixation with plates and screws eliminated the need for external immobilization following arthrodesis.

Today a total wrist arthrodesis utilizes a special compression plate that allows rigid fixation with larger screws proximally and smaller screws distally, in order to reduce the risk of fracturing the metacarpals. Limited intercarpal arthrodeses continue to utilize combinations of Kirschner wires (K-wires), compression bone screws, staples and structural bone grafting.

New specialty plate and screw constructs are being introduced in both limited and total arthrodesis, which today are procedures indicated for trauma, carpal instability, avascular necrosis, tumor damage, septic and rheumatoid arthritis. Arthrodesis may also be used for stabilization of the wrist when combined with tendon transfers, in the correction of deformities, as well as in the salvage of unsuccessful wrist arthroplasty.

Arthroplasty is a joint reconstruction procedure used to either reshape or replace damaged joints - as a result of degenerative conditions such as arthritis. The goal of this procedure is to restore the function of a stiffened joint and relieve pain. It has been used for years in hip and knee joints, in order to relieve the pain and disability associated with advanced osteoarthritis.

There are primarily two types of arthroplastic procedures: joint resection and interpositional reconstruction. In a joint resection, a portion of the bone is removed from the the stiffened joint to allow additional space and room for improved range of motion.

Interpositional reconstruction entails reshaping the joint and placing a prosthetic disk between the two bones that form the joint.

And total joint arthroplasty is the complete replacement of the joint with an artificial one.

A prosthesis, or artificial joint, may be made of plastic, metal, silicone and ceramic material - or created from body tissue such as skin, muscle or fascia. Artificial joints are generally cemented into place once soft tissue is temporarily moved aside and a space within the deteriorating joint is cleared.

The type of prosthesis depends on the joint being replaced. Silicon hinges are proving effective in smaller finger (phalangeal) joints

More recently, a growing number of prostheses and implants have been created for upper extremity joints. And those for the thumb and wrist joints continue to evolve as understanding of small articular surfaces with complex curvatures improves.

Improved technology in small joint implants is evident in the reduced recovery time and outcome in CMC Arthroplasty reconstruction patients treated with a new small bone implant. A CMC Arthroplasty procedure entails removing one of the carpal bones of the wrist and filling the space with a portion of the flexor carpi radialis tendon. The thumb bone (first metacarpal) is firmly secured until the inserted tissue becomes encapsulated.

Before any joint reconstruction procedure is complete, a series of tests are performed to ensure proper range of motion and correct movement.

Total Joint Arthroplasty

The crippling effects of arthritis on the small finger joints can in severe cases make even simple tasks, such as buttoning a shirt or holding a pen, difficult. Severe contractures can lock fingers into positions that make many daily tasks impossible. As joint deterioration continues, pain increases. In such cases, metacarpal phalangeal (MP) joint replacement can correct deformity, help restore function, and relieve pain.

A total wrist replacement, or wrist arthroplasty, is indicated when a wrist that has sustained a traumatic injury or has been affected by a severe degenerative disease such as arthritis is nonresponsive to other treatments and is no longer able to function properly. In some cases patients suffer from severe pain in the wrist and may have lost the ability to use it. Replacing the wrist joint with an artificial one helps eliminate pain and recover diminished strength in the wrist, by restoring length to the muscles and tendons of the fingers and wrist. This improves motion and stability necessary to perform everyday activities.

Elbow arthroplasty is commonly performed for the same reason as those mentioned above - joint damage resulting from arthritis - and is considered only after all other treatment options have first been exhausted. The artificial joint replaces the damaged surfaces and eliminates the pain of bone rubbing against bone, while also improving elbow movement.

Joint replacement of the elbow may also be required when elbow fractures in elderly patients suffering from osteoporosis make fixation of the soft bone an impossibility.

Resection arthroplasty is one of the most common procedures for surgically treating AC Joint Arthritis. It involves the removal of the last half-inch of the collarbone - leaving a space between the acromion, on the roof of the shoulder blade, and the cut end of the collarbone. The main ligaments remain intact.

Scar tissue then develops to replace the joint and allow movement to occur without further abrasion of the ends of the arthritic bone. The procedure maintains the flexible connection between the acromion on the shoulder blade and the collarbone.

Resection arthroplasty can be done as open surgery with a small one-inch long incision, or arthroscopically. Recovery is similar with both procedures.

Patients usually return home wearing an arm sling. Stitches are removed approximately one week later and movement becomes easier each day thereafter. A series of rehabilitative and strengthening exercises assist in the full resumption of movement over the next several months.

A trapeziectomy is the complete removal of the trapezium bone - one of the eight carpal, or wrist, bones. It is located at the base of the thumb, which is a common site for arthritis, because the range of motion of the thumb predisposes the joint to instability and increased wear. It is a condition that eventually leads to increased joint stiffness, pain, and ultimately deformity in the thumb. While activity changes, anti-inflammatory medication, splints and steroid injections can temporarily alleviate symptoms, surgery is the only permanent solution.

A trapeziectomy is indicated when the joints both above and below the trapezium are arthritic. More frequently today a simple trapeziectomy with a small modification, also known as hematoma and distraction arthroplasty, is used - and yielding a high success rate. In this procedure, the trapezium is removed in small sections, and Kirschner wires (K-wires) are used to help internally stabilize - affixed to the first metacarpal in slight distraction and opposition. The procedure is then followed by a period of immobilization.

The procedure successfully eliminates pain and dramatically improves range of motion and grip and pinch strength.

When compressed nerve conditions are nonresponsive to conservative treatment, surgical intervention may help relieve the pressure and release the area of compression.

Generally performed as an outpatient procedure, patients are given either a general or regional anesthetic depending on the location of the nerve. In most nerve decompression procedures involving the hand and arm, an axillary block is used. An incision is made over the area of suspected compression and the soft tissue is gently moved aside in order to examine all possible areas responsible for compressing or pinching the affected nerve. When identified, compression is relieved. The manner in which compression is relieved depends on the source of the pinching or compression.

The skin is then sutured and rehabilitative exercises begin once the surgical site begins to heal.

When cubital tunnel syndrome is nonresponsive to conservative treatment, a surgical procedure called Ulnar Nerve Transposition is performed in order to relieve the pressure on the ulnar nerve. This is accomplished by moving the ulnar nerve to the front of the elbow and placing it beneath a muscle layer, which in turn protects it from the bony groove when the elbow bends. This location under the muscle also provides the nerve with added protection from injury. The procedure makes necessary adjustments to the new site of the ulnar nerve, in order to prevent compression in its new location.

Beginning with an incision along the backside of the elbow with special care given to the nerves in the area, the bands of pressure entrapping the ulnar nerve are then identified and released. Muscle is then lifted from the bone and an area void of future nerve compression is created. Any scar tissue or other damage evident in the area is addressed and the opening is closed with sutures.

A recovery period is followed by rehabilitative and strengthening exercises, in order to rebuild muscle function and promote nerve regrowth.

When lateral epicondylitis, or tennis elbow, does not respond to conservative treatment, surgery may be indicated in order to relieve the tension off the extensor tendon at the elbow joint.

In an outpatient surgical procedure using an axillary block to numb the arm, an incision is made on the outside of the elbow over the lateral epicondyle. Soft tissues are gently moved aside allowing clear view of the tendons. Degenerative tissue and bone spurs may be removed as the tendons are explored. The extensor tendon is then cut where it connects to the lateral epicondyle and split, allowing any extra scar tissue to be removed. It may be necessary to cut the tendon at its attachment to the bone and remove a small portion of the bone to improve the blood supply to the area.

Rehabilitative exercises begin when sufficient healing of the surgical site is evident.

A surgery popularized by the former pitcher for the Los Angeles Dodgers, Tommy John, is changing the nature of elbow injuries for today’s athlete. What were once considered career ending injuries - ulnar collateral ligament (UCL) tears - are now managed with this surgical procedure developed to return athletes to their sport.

Known to physicians as UCL Reconstruction, the goal of the one-hour procedure is to replace the damaged ligament of the medial elbow and replace it with a tendon from, either the patient's forearm, hamstring or foot.

The rehabilitation and reconditioning program that follows is extensive. And it is an essential part of the overall treatment for athletes.

Tommy John was the first professional athlete with an elbow injury to undergo the surgery and return to pitching. And today nearly 90 percent of those undergoing the surgery are expected to make a complete recovery.

The surgery is also used in some cases to treat medial epicondylitis (Golfer's Elbow) and lateral epicondylitis (Tennis Elbow).