An arthrodesis is the creation of joint ossification – or bone growth – between two bones by surgical means. It is a procedure I do to help manage intractable joint pain which has failed to be relieved in other ways, and is having a significant impact on their daily life. Usually these patients have failed not only medical management, but may have undergone previous surgery.
Typically, an arthrodesis is done when the problem lies with just one joint. It is usually a smaller joint like the great toe, but can include ankle, knee or even hip. To spare this painful joint the patient puts unnaturally large pressure on their lower back, as well as the non-damaged hip and knee, causing both pain and damage to these joints as well.
Traditionally, the method I use involves a bone graft, which is usually taken from the patient (called an autograft) or from a bone-bank using donor bone (called an allograft). Autografts are preferable, for bone taken from the patient contains their own native bone-forming cells (osteoblasts). The presence of these living osteoblasts allows new bone to form on the matrix of the graft. This allows more emphasis to be put on joint preservation.
I find one of the limiting factor to using a bone autograft for an arthrodesis is the limited supply of bone available – obviously, a patient can only donate so much bone. It would be such a help to just simply order some 3D printed bone.
What fascinates me is the potential of newer materials (artificial or synthetic grafts). Synthetic bone substitutes have been previously developed, but we have now been able to create custom-made plates. I have successfully used this method to design an individual joint for a patient who had failed previous repeated surgery.We are also working on making custom made plates out of bone. Imagine a plate and screws which is bone and just incorporates. Arthrodesis was the only option remaining, and by making use of the new technology I helped someone with minimal movement and ongoing pain to regain their mobility.
The technology is now available to accurately map a patient’s joint and ligaments; this is used to print using 3D technology to replace the affected joint with one tailor-made to match their anatomy. With my research and collaboration with Sydney University and Allegra Orthopaedics, I know we are not far away from the day when CT scanning combined with 3D printed bone will allow the optimal tailor-made joint replacement.
This is a particularly exciting time to be an Orthopedic Surgeon – outcomes that we could only dream about 10 years ago are now a real possibility.
The Bone Surgeon (Dr Nick Hartnell) is an Orthopaedic Surgeon located in the Southern Highlands of NSW. He specialises in the care of patients surgically while still having a strong belief in the art of non-operative management.
He completed a Bachelor of Medicine and Bachelor of Surgery at the Sydney University in 1995. He then went on for his intern year at the Canberra Hospital. Since that time he has been fully focused on orthopaedic training and specialisation and has many years of experience in all facets of Orthopaedic care and carries out procedures in:
- Bowral and District Public Hospital
- Campbelltown Private Hospital
- Southern Highlands Private Hospital
- Goulburn Base Hospital
Dr Hartnell and his family live in Bowral, NSW.
You can contact The Bone Surgeon at www.bonesurgeon.com.au