arthrodesis

Indications

Very few

- young labourer with severe disabling elbow pain

- trial in POP at 90^o for 6 weeks

Poor function

- adjacent joints cannot compensate for loss of function

Contraindications

RA

- high failure rate especially flail elbow with poor bone stock

Indications

Severe LBP 

- most common indication

Ipsilateral knee pain

- less beneficial

Malposition

- especially abduction

Contraindications

Absent abductor mechanism

Flail

Active infection

Insufficient bone stock

Examination

LLD

Indications

Young adult 

- 16 - 30 years old

- monoarticular disease

- heavy demand 

Exhausted options of osteotomy

- risk of THA failure  / multiple revision surgeries considered too high

Aims of arthrodesis

Maximise bony contact

Minimise shortening

Definition

Painful restriction of dorsiflexion of the great toe 

- secondary to degenerative changes in MTPJ

- initially pain and synovitis

- osteophytes don't form medially or on plantar aspect

Epidemiology 

Two peaks

1.  Adolescence F > M

2.  Middle Age M > F

Aetiology

Often Idiopathic

Trauma