Triple Arthrodesis
SurgeryTriple arthrodesis is the procedure where the three joints in the back of the foot, below the ankle, are fused. Surgery to get different bones to grow together is called Arthrodesis, or Fusion. The talus, calcaneus, navicular and cuboid bones are all made to grow together into one bone mass. This is the common surgical technique used to treat hindfoot arthritis. It can also be used for treating hindfoot deformities, instability problems, and the residuals of posterior tibial tendon problems.
This surgery requires hospitalization for at least one night, and often two. You will require a General anesthetic or Spinal anesthetic.
During the surgery two incisions will be made about the inside and outside of the hindfoot.
The bone ends are prepared by removing any remaining cartilage, and the bones put together and held with some combination of screws and bone staples.
A Bone Graft is often used to fill any gaps in the bones, and improve the chances of solid fusion. This is routinely taken from the iliac crest, above the hip. That will be taken from the same side as the foot.
Day of Surgery
At the end of the surgical procedure the wounds are covered and a Short Leg Plaster Splint is applied. That dressing gives support to the foot, holding it securely. That should be left in place until I change it at the first post-operative office visit.
You will be given crutches or a walker at the hospital, and I want you to not put any weight on that leg for 6 weeks. In the hospital a physical therapist will instruct you in using the crutches or walker. Do not walk on the splint.
You must remain Non-Weightbearing on the surgery side for 6 Weeks.
When your pain is under control, and you can safely get around without putting weight on the ankle, you may go home.
Look here for things to watch after Inpatient Surgery.
Post-operative Course
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the splint and dressings, wash your foot, and generally take out the skin Staples or Stitches.
I will then put your leg into a Short Leg Cast. This is not a walking cast, so you will still need to use the crutches or walker. You will wear this until 6 weeks after the surgery. Do not walk on the cast.
The second post-operative visit is usually at the 6 week point. At that time I will remove the cast, and check to make sure that everything is healing satisfactorily. I will then have you go into a CAM Walker, and you will wear that for Protected Weightbearing for an additional 6 weeks. You must wear it when you do any walking.
I will ask to see you next after an additional 6 weeks, the 3 months point after surgery. I will have you get an Xray then to make sure that the arthrodesis is healing satisfactorily, and there are no problems with the metal implants. I will allow you to go into a regular shoe then.
Most people “wean” off the CAM Walker and back into a regular shoe. This takes a variable amount of time, and depends on how comfortable the regular shoe feels. It may take a few days, or up to a month.
Most patients have swelling about the surgical area that lasts for about 4 months after surgery. It generally takes 9 – 12 months for complete healing to occur.
Final Results
The goal of the surgery is to leave you with a painless foot that will allow normal walking. How successful that will be is variable. It is usually possible to make the foot pain-free for daily activities. Most patients will have some degree of soreness that is hopefully mild. Most patients will notice discomfort when the weather changes.
Loss of hindfoot motion will put a restriction on the types of shoes you can wear. Generally a flat shoe will be okay. You will probably not be able to wear a heel over 1 inch.
Loss of hindfoot motion will make walking on any surface that is irregular difficult. That would include gravel, sand, or on a trail. You may have trouble walking well along an incline. You should be able to walk on flat surfaces fine.
It usually takes one year for maximum improvement to occur.
Complications
Complications can occur with any surgery. Go here for a general discussion of Surgical Complications.
Specific risks of this surgery include the possibility of the bone not healing, or non-union, and implant problems. It would be rare for triple arthrodesis to cause problems in the ankle joint in the future. You may develop arthritis further down in the foot over the ensuing years.
All credit goes to http://www.georgelianmd.com/cms/Procedures/TripleArthrodesis/tabid/62/Default.aspx
Triple Arthrodesis Procedure
A triple arthrodesis is a commonly performed procedure for chronic
tendon ruptures, partially foot dislocations such as a flat foot among
other causes of hindfoot arthritis. Non-surgical treatment often begins
with fracture brace to control initial pain and swelling. The tendon
dysfunction may then be treated with a permanent ankle or leg brace. If
non-surgical treatment does not relieve your symptoms satisfactorily or
if signs of progressive flattening are noted, surgery is recommended. It
involves fusion of the four hindfoot bones (the calcaneus, talus,
navicular and cuboid). Tendon balancing and bone grafting procedures
are performed with this surgery to improve results. Pain relief is
excellent. Gait improves significantly because of decreased pain but,
20% of up and down motion and all of side to side to side motion are
lost. The surgery may be performed on an inpatient or outpatient basis
depending on your particular needs.
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Pre-operative Care
The surgical center will inform you when to arrive and how to prepare for surgery. The day of surgery you will receive regional anesthesia known as a popliteal nerve block by the anesthesiologist just prior to surgery. You will be placed on your stomach and a small needle is used to inject Novocain-like medication around the nerve in your leg. It gives complete pain relief that lasts for 12 to 36 hours. Patients report extraordinary satisfaction with this type of anesthesia. You will be given antibiotics just before surgery to help prevent infection.
Operative Care
During the surgery you will undergo general anesthesia. A tourniquet will be placed around your thigh. Incisions will be made along the foot, ankle, back of the leg, and bottom of the heel. Bone graft is taken from the knee. The joints have their surfaces roughened to imitate a fracture. The foot is repositioned to recreate an arch and balance it beneath the leg. Screws are used to hold the bones in place while they grow together. Tendon balancing is performed. X-Rays taken during the surgery confirm the correction of the foot misalignment. The wounds are closed with stitches and staples.
Immediate Post-Operative Care
Once your anesthesiologist is satisfied that have recovered you will be admitted to the hospital. Inpatient stays usually vary from 1-3 days. Physical therapy will teach you how to walk with crutches or a walker. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wearing off. Remember post operative pain is much easier to control with prevention. Schedule your post-operative visit for 2 weeks after surgery when you are able.
To schedule surgery, please contact us at info@anklefootmd.com or 952-920-4333 Ext. 5 four weeks in advance to best ensure your desired surgery date. If you have questions after surgery, please contact my office and ask for my medical assistant.
Post-Operative Course – Triple Arthrodesis
This timeline is a general guideline. Your post-operative course may vary.
This timeline is a general guideline. Your post-operative course may vary.
| Elevation | 23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months. |
| Motion | Move your toes and knee when the block resolves. This will decrease pain and swelling, and improve healing. |
| Walking | If you are healing well begin partial weight bearing at 6 weeks in cast or fracture brace when you have permission. Once the fusion heals you may weight bear without restrictions. |
| Bathing | Keep cast dry. Use a Xerosox. There are no restrictions after the cast is removed. If you have an External fixator, wash daily and follow instructions. |
| Dressing | Keep Cast clean and dry |
| Pain Control | Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Ultram (Rx only). NSAIDS will slow healing. |
| Work | Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor will take at least 3 months. |
| Driving | Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery must wait until healing is adequate and they feel safe. |
Routine Clinic Visits
| 2 weeks | XR, cast exchange and stitch removal |
| 6 Weeks | XR, Earliest time of bone healing to permit weight bearing activity. The time to return for your next visit varies significantly. |
| 3+ and 6 months | Return for recheck and XRs; Strength improves over then next year. Minimal feelings of discomfort may linger, your overall comfort level improves over a year. |
| ********** | If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office. |
