Definition

Arthrodesis fuses (welds) together the two bones that form a joint. There is no longer movement in the joint after the procedure. One or more related joints may be done at the same time.

Arthrodesis of Foot and Ankle

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Parts of the Body Involved

Arthrodesis can be performed on any joint. In this case, it is the ankle and foot joints.


Reasons for Procedure

Ankle arthrodesis is performed to relieve disabling ankle pain or deformity caused by poorly healed fractures, arthritis , infections, or developmental defects.

Although some joints (for example hips and knees) can be replaced with artificial devices, the ankle usually does better with arthrodesis than with joint replacement.


Risk Factors for Complications During the Procedure

Cigarette smoking, infection, some chronic diseases, and certain bone diseases in the ankle can prevent successful fusion. Cigarette smokers experience up to 16 times the failure rate of nonsmokers.


What to Expect

Prior to Procedure

Your orthopedic team will likely have tried several nonsurgical methods of correcting your problem before resorting to surgery. These may include medications, injections, special shoes, or types of physical therapy. The surgery takes place in a hospital operating room. You will have a thorough evaluation to determine your overall health and any risk factors.

Anesthesia

Foot and ankle arthrodesis can be done under general or spinal anesthesia .

Description of the Procedure

There are two different techniques used in performing an arthrodesis, open or arthroscopic.

  • An open procedure uses a long incision and direct visualization of the joint.
  • Arthroscopic surgery uses tiny incisions, a thin arthroscope with a tiny camera attached to a television, and thin instruments inserted into the joint through the tiny incisions.

The orthopedic surgeon will select the technique depending upon his experience and your particular anatomy. There are many ways to secure the two bones together so that they no longer move in relation to one another. Long screws, screws and steel plates, long steel rods, and bone grafts have all been used.

You will have a tourniquet strapped around your thigh to shut off circulation so that the surgery can be performed in a bloodless field. Your leg will suffer no ill effects from the tourniquet.

After Procedure

Your lower leg will be in a rigid cast and elevated after surgery. You will be offered pain medication.

How Long Will It Take?

Depending upon how many joints are to be fused, the procedure may last from 2-5 hours.

Will It Hurt?

There will be no pain during the procedure. Afterwards there will be some discomfort.

Possible Complications

  • Failure of the joint to solidify occurs at least 7% of the time. It can be up to 25% or more if risk factors such as smoking are present.
  • Occasionally the alignment of the end result is unsatisfactory, causing pain and/or an altered gait and requires repeat surgery.
  • Local infection and nerve damage are also possible.
  • One leg usually ends up a bit shorter than the other, requiring a special shoe to equalize the length.

Average Hospital Stay

Barring complications, you may be able to go home in 2-4 days.

Postoperative Care

It will take up to four months to heal and solidly fuse the joint(s). During that time you will be in a cast.


Outcome

Satisfactory results including good pain relief are achieved in over 80% of patients. Most can wear ordinary shoes. Some will benefit from specially fitted footwear.


Call Your Doctor If Any of the Following Occurs

  • Bleeding or discharge from the incision(s) (staining through the cast)
  • Fever
  • Increasing or unremitting pain