JUNE 2008

ARTHRODIASTASIS

There are a variety of pathological conditions that exist which cause severe pain and debilitating degenerative conditions within the joints, one of the more common conditions would be arthritis (rheumatoid, degenerative, post-traumatic). The cartilage becomes damaged to the point where there is formation of osteophytes or lipping and this contributes to hallux limitus or rigidus conditions and/or joint deterioration. Arthrodiastasis is a surgical technique that has now become an alternative to the more invasive procedures such as implant arthroplasty, realignment osteotomies, or joint arthrodesis while offering the following benefits; • Prevent bone on bone contact within the joint decreasing pain and degeneration. • Allows weight bearing during the postoperative period so that the distracted joint can adapt to pressure changes in the synovial fluid which increases proteoglycan metabolism reestablishing cartilage health stabilizing and strengthening the joint. • Releasing stress in subchondral bone decreasing the risk of bone sclerosis that leads to lipping or rigidus conditions. Arthrodiastasis involves gradual distraction of the joint; this is accomplished by applying an external fixator which is then used to stretch the joint capsule. It is critical that the joint only be stretched 5mm – 10mm at a time otherwise you may only achieve a “rubber band effect” stretching the joint and then having it contract back to it’s original position once the external fixator is removed. Fixation system is commonly left in place for 6-10 weeks. You should also note that any underlying deformity will not be corrected such as the osteophtye lipping so an accompanying procedure is usually necessary and critical to a successful outcome. Hallux Limitus Joint Same Joint After Arthrodiastasis For the purposes of CPT coding report the application of the external fixation system and any accompanying procedure(s) performed on the joint during that operative session.