Tibiotalocalcaneal Arthrodesis - Indication, Benefits, and Procedure

Introduction

Tibiotalocalcaneal arthrodesis is a surgical procedure that involves fusing the ankle joint, the subtalar joint, and the heel bone. This procedure is performed on patients with severe arthritis or deformities in their ankle joints who have not responded to other conservative treatments. It can also treat severe ankle fractures or other conditions that cause instability in the ankle joint. The procedure removes the damaged joint surfaces in the ankle and subtalar joints and then inserts screws or plates that hold the bones together while they fuse. The surgery is done under general anesthesia and requires a hospital stay of several days. After surgery, patients must wear a cast or brace for several months while the bones fuse.

What Are the Indications for Tibiotalocalcaneal Arthrodesis?

Some of the specific indications for this procedure include:

• Ankle Joint Arthritis: Patients with severe arthritis in the ankle joint may experience chronic pain, inflammation, and instability that cannot be effectively managed with medication, physical therapy, or other conservative treatments. In these cases, tibiotalocalcaneal arthrodesis may be recommended to fuse the joint and create a more stable, pain-free structure.

• Deformities or Malalignment: Patients with ankle joint deformities or malalignment may also benefit from tibiotalocalcaneal arthrodesis. This can include conditions such as ankle valgus (inward tilting of the ankle), ankle varus (outward tilting of the ankle), or severe ankle pronation (rolling inward of the foot). By fusing the joint, the surgeon can correct these deformities and improve overall function and stability.

• Failed Ankle Replacement Surgery: In some cases, patients may have undergone ankle replacement surgery that has failed to relieve their symptoms or has resulted in significant complications such as loosening or instability of the joint.

• Severe Ankle Fractures: Patients who have sustained severe ankle fractures may also require tibiotalocalcaneal arthrodesis if the fracture cannot be effectively stabilized with other treatments such as casting, bracing, or surgery. This can help to promote healing and prevent long-term complications such as chronic pain, instability, or arthritis.

What Are the Benefits of Tibiotalocalcaneal Arthrodesis?

Some potential benefits of tibiotalocalcaneal arthrodesis surgery:

• Increased joint stability and function.

• Improved gait and mobility.

• Prevention of further joint damage.

• Correction of deformities in the ankle or foot.

• Reduced need for pain medication.

• Improved quality of life.

• Return to normal activities and work duties.

• Long-lasting or permanent pain relief.

What Is the Procedure of Tibiotalocalcaneal Arthrodesis?

The surgery is performed after giving general anesthesia and can take several hours to complete. The following steps are the general description of the procedure:

• Incision: The surgeon put an incision over the ankle joint, typically on the inner side of the ankle. The incision may vary in length depending on the individual case.

• Removal of Damaged Tissue: The surgeon will remove any damaged cartilage or bone from the ankle and subtalar joints. This may involve removing small pieces of bone or using a saw or drill to remove larger sections of bone.

• Preparation of Bone Surfaces: The surgeon will then prepare the surfaces of the bones that will be fused. This may involve using a saw or drill to create a rough surface on the bone, which will help the bones to fuse more effectively.

• Insertion of Screws or Plates: The surgeon will then insert screws or plates into the bones to hold them together while they fuse. The screws or plates may be inserted through the skin or small incisions in the skin.

• Closure: The surgeon then closes the incision with sutures or staples. In the end, the surgeon applies a dressing or cast to protect the surgical site.

What Is the Postoperative Care For Tibiotalocalcaneal Arthrodesis?

After tibiotalocalcaneal arthrodesis surgery, following a comprehensive postoperative care plan is essential to allow proper healing and prevent complications. The following are some general guidelines for postoperative care:

• Pain Management: It is normal to experience pain and discomfort after surgery. Pain medication will be prescribed to help manage pain during the initial recovery period.

• Rest and Elevation: Rest is essential for proper healing. Keep the affected foot elevated to help reduce swelling and promote healing.

• Follow-up Appointments: Keeping all scheduled follow-up appointments with the surgeon is essential. They will monitor the healing process and make any necessary adjustments to the treatment plan.

• Physical Therapy: Physical therapy will be recommended to help regain strength, flexibility, and mobility of the affected joint after the cast or brace is removed.

• Weight-Bearing: Patients should avoid putting weight on the affected foot for several weeks after surgery. The surgeon will provide specific instructions regarding when it is safe to begin bearing weight on the affected foot.

• Wound Care: Keep the surgical site clean and dry to reduce the risk of infection. Follow the surgeon's instructions regarding changing dressings and cleaning the wound.

• Assistive Devices: Patients may need to use crutches or other assistive devices to get around during the initial recovery period.

• Activities: Avoid strenuous activity or exercise until cleared by the surgeon. Patients should also avoid activities that involve twisting or putting stress on the affected joint.

• Nutrition: Proper nutrition is essential for proper healing. Follow a healthy diet and stay hydrated.

• Smoking and Alcohol: These interfere with healing. Avoid smoking and limit alcohol consumption during the recovery period.

What Are the Contraindications of Tibiotalocalcaneal Arthrodesis?

Certain conditions may make the procedure contraindicated or unsuitable for some patients. These include:

• Infection: If there is an active infection in the affected joint, surgery may need to be postponed until the infection is cleared.

• Poor General Health: Patients with significant medical conditions such as heart, lung, or kidney disease may be at increased risk of complications from surgery.

• Poor Bone Quality: Patients with poor bone quality, such as those with osteoporosis or previous fractures, increase the risk of complications from surgery.

• Nerve or Vascular Damage: Patients with nerve or vascular damage in the affected foot or ankle may not be suitable candidates for surgery.

• Severe Arthritis: In some cases, severe arthritis may make tibiotalocalcaneal arthrodesis surgery unsuitable or less effective.

• Active Smoking: Patients who smoke may be at increased risk of complications from surgery and may be advised to quit smoking before surgery.

What Are the Complications of Tibiotalocalcaneal Arthrodesis?

While tibiotalocalcaneal arthrodesis surgery can be effective in relieving pain and improving joint function, it also carries some potential risks and complications, including:

• Non-union: The fusion of the bones may not heal properly, resulting in a non-union. Additional surgery may be required to address this complication.

• Malunion: The bones may heal in an abnormal position, leading to a malunion. This can cause joint stiffness, pain, and reduced function.

• Infection: Infection at the surgical site can occur and may require antibiotics or additional surgery.

• Nerve Damage: The nerves that supply the foot and ankle may be damaged during the surgery, leading to numbness, tingling, or weakness.

• Blood Clots: Blood clots form in the deep veins of the leg or pelvic area, leading to potentially life-threatening complications such as pulmonary embolism.

• Hardware Problems: Screws, plates, or other hardware used to stabilize the joint may cause irritation or require removal due to loosening, breakage, or other issues.

• Chronic Pain: While the surgery aims to relieve pain, some patients may experience persistent or chronic pain after the procedure.

• Joint Stiffness: The fused joint may be stiffer and less mobile than a healthy joint, affecting gait and function.

• Complications From Anesthesia: The use of general anesthesia carries risks such as allergic reactions, breathing problems, and cardiac complications.

Conclusion

Tibiotalocalcaneal arthrodesis surgery is a major procedure that can provide significant pain relief and improve joint function for patients with ankle and foot conditions. However, like any surgery, it carries potential risks and complications. Patients should carefully weigh the potential benefits and risks with their healthcare provider and follow post-operative care instructions to optimize their recovery.