Ankle arthrodesis: surgery, consequences, rehabilitation, patient reviews

Not all pathological conditions of the musculoskeletal system can be eliminated by improving the quality of structural elements. In some cases, the function of one or more segments is required to be blocked. Arthrodesis of the ankle joint is just such a surgical intervention. Its purpose is to remove non-viable elements, correct the axis of the lower limb and further fix the anatomical structures in the physiological position. What are the conditions of arthrodesis of the ankle joint? What are the consequences of intervention and the principles of rehabilitation? About this - later in the article.

Indication for the operation

Artrodes is an intervention in which the joint is immobilized and fixed artificially in the desired position. The necessity of a surgical operation is inevitable in the following cases:

1. The presence of a dangling joint. This condition occurs against the background of deformation of the interosseous joint. It can be partial or complete. The result of deformation is a violation of physiological activity within the joint (prolonged muscle paralysis, ligament rupture, gunshot trauma, excessive extension of the joints).
2. Development of deforming arthritis. Arthrodesis of the ankle, reviews about which you can read below, is required for purulent, traumatic and tubercular form of pathology.
3. Degenerative arthrosis with complications. Pathological conditions entail changes in the bony epiphyses.
4. Complications of poliomyelitis.
5. A fracture that is not properly fused or fused in the past.
6. If it is necessary to implant a part or the entire joint, if other types of interventions are not possible.

Contraindications

Arthrodesis of the ankle (consequences of a negative nature and complications observed after surgery are very rare) is prohibited in the following cases:

• Until adolescence, while the musculoskeletal system is in the growth stage;
• Presence of fistulas of non-tubercular nature, caused by the pathological effect of atypical mycobacteria;
• Presence of infection in the field of intervention;
• Severe condition of the patient, lack of stability in dynamics.

After 60 years of operation, arthrodesis of the ankle joint can also cause serious complications.

Types of intervention

There are five main types of surgery, depending on the course of manipulation and the technique used:

• Intra-articular arthrodesis of the ankle is performed by removing the articular cartilage.
• The extra-articular procedure occurs by bonding the bone elements with material taken from the body of the same patient. It is possible to use a donor transplant.
• Combined arthrodesis of the ankle joint combines both types of surgery. From the joint, the cartilage is removed and the bone is cemented with a graft by implanting special metal plates.
• Extension type of operation is based on the artificial fracture. Then the bone elements are fixed in a physiological immobilized position and stretched out by the apparatus. In other words, this type of intervention is called "arthrodesis of the ankle by the Ilizarov apparatus."
• Compression operation is carried out by fixing the joint elements using spokes, hinges, rods and other specific devices used in traumatology.

Applied anesthesia

Local anesthesia with such a surgical intervention is not used due to the fact that manipulation takes place on deep bone and cartilaginous structures. Apply the following types of anesthesia:

• Endotracheal anesthesia - the patient is immersed in analgesic sleep by inhaling special medicines fed in gaseous form;
• Spinal anesthesia - the patient is in a conscious state, sees and hears everything, but the lower limbs are completely immobilized and devoid of sensitivity;
• Combined anesthesia - spinal anesthesia combined with immersion in the state of half-dormancy, is used for too suspicious and sensitive patients.

Arthrodesis of the ankle joint, patients' testimonies, which indicate that the operation is quite long, can last from 2 to 6 hours. It depends on how hard the primary condition is, on the technique of intervention chosen and the need to use the same patient's transplant.

Preparation of the patient

Arthrodesis of the ankle, patients' testimonies about which indicate the necessary preoperative preparation, requires a complete examination of the patient. As before any intervention, the patient must undergo clinical tests of blood, urine, biochemistry. Determine the state of coagulability, blood group and Rh factor. The tests for HIV infection, syphilis, hepatitis, x-rays are considered mandatory.

7 days before surgery, it is necessary to abandon the drugs that affect the blood coagulation system and non-steroidal anti-inflammatory drugs. In the last 24 hours only light food is allowed. In the morning before the intervention, it is forbidden to eat and drink water to avoid possible complications during anesthesia.

It is necessary, while the patient is in a hospital, it is necessary to prepare a comfortable atmosphere in the house. Take care of such things in advance:

• Remove the rugs on which you can slip;
• Maximally compactly arrange the wires that lie on the floor so that the patient does not catch on to them;
• In the bathroom to buy a mat with suckers, so that it does not move on the wet floor;
• Place all the necessary devices for carrying out hygiene procedures as closely as possible, so that you do not need to drag on them.

Techniques for conducting

The arthrodesis of the ankle after obsolete trauma or infectious processes that led to impaired functional abilities is carried out in several stages:

1. The intervention area is treated with antiseptics and covered with sterile surgical linen.
2. In the projection of the joint, an incision up to 15 cm in length is made. Fascia and muscles are dissected in layers until the articular surfaces are removed into the wound.
3. Cartilage tissue is removed, unviable and injured joint elements are extracted.
4. The surfaces of the talus and tibia, which will fit tightly to each other, are formed accordingly. This is done in order to establish the correct axis of the lower limb.
5. The resulting structure is fixed with special metal appliances in a fixed manner.
6. After a while, the bone elements will grow together and the joint will no longer have the original appearance. Its functions will be partially shifted to other elements.

What other joints operate

An arthrodesis is not a specific intervention designed specifically for the ankle joint. In the same way, trauma surgeons can immobilize the following anatomical areas:

• Hip joint - produce an excision of the meniscus and fix the head of the femur to the pelvic bone, the joint remains completely immobile;
• Bone knee joint - allowed only in the absence of pathologies of the cardiovascular system;
• Shoulder joint - an intervention in which the bone graft of the patient is most often used (so that there is no rejection) or donor;
• Metatarsophageal articulation - the aim of the intervention is to eliminate valgus or iatrogenic deformation of the thumb, the joints retain mobility after the recovery period.

The reasons that require arthrodesis of these joints, correspond to all of the above.

Recovery period

The arthrodesis of the ankle joint, photo of which allows to get a detailed idea of the operation, requires a long recovery. The first day you can not get out of bed to avoid possible complications after anesthesia (dizziness, headache, vomiting).

The doctor prescribes the use of analgesics and non-steroidal anti-inflammatory drugs for the relief of pain. If necessary, antibacterial drugs are used. This is associated with a high risk of suppuration in the location of foreign bodies (spokes, plates, rods). From antibiotics preference is given to the least toxic for the patient's body:

1. Cephalosporins - "Cefotaxime", "Ceftriaxone".
2. Macrolides - "Erythromycin", "Clarithromycin".
3. Penicillins - "Ampicillin", "Ampioks".

Some time after the operation, it is necessary to wear a plaster bandage so that the exposed position of the lower limb remains the same in which it was fixed by a specialist. The duration of the use of gypsum can last up to 3-4 months.

The doctor will advise the patient when it is possible to wet the place of operative access. Independently it can not be done to prevent infection of the region. After removal of the plaster bandage, a repeated X-ray examination is necessary to confirm the correct fusion of the bone elements.

The first 2 months to step on the operated leg is prohibited, so you need to buy crutches and move only with them. After 3 months after the X-ray, a surgeon-trauma surgeon can begin to rely on the leg and use physiotherapeutic methods of treatment.

Physiotherapy

Rehabilitation after arthrodesis of the ankle joint involves the inclusion of physiotherapy, massage and other elements in the postoperative recovery stage. Therapeutic exercise is the most important method, because it is thanks to it that patients prevent the development of joint contracture.

From other physiotherapeutic procedures the doctor appoints:

1. Electrophoresis - the zone of the ankle joint is affected by permanent electrical impulses. With their help, you can enter medications, relieve inflammation, stop soreness, eliminate puffiness, normalize metabolic processes, and activate blood supply to the surgical intervention zone.
2. UHF is a procedure in which an ultrahigh frequency electromagnetic field affects the cells and tissues. UHF promotes activation of regenerative processes, healing of fractures and wounds, removes puffiness, removes pain, stimulates local blood circulation.
3. Magnetotherapy - manipulation, in which a magnetic field is used. The pain and edema are eliminated, the possibility of infection of the area of intervention is prevented, the elasticity of the vessels is increased, and blood circulation in the affected area is improved.
4. Laser therapy - it is possible to use the surface and intraosseous methods of exposure, which are part of the treatment and recovery after joint diseases.

Arthrodesis of the ankle, rehabilitation after which can last up to 8 months, requires the patient's constant work on himself. Only in this case it is possible to avoid the development of complications and restore the function of the operated area.

Possible complications

Like any surgical intervention, ankle arthrodesis can have a number of complications:

• Infection of the joint with the further development of osteomyelitis;
• Bleeding, formation of a hematoma;
• Paresthesia - a violation of sensitivity as a result of dissection of small plexus;
• Lack of joint fixation;
• Lameness and other pathologies of gait;
• The need for additional surgical interventions;
• Deep vein thrombosis of the lower limb;
• Thromboembolism of the main arteries.

Be sure to tell the specialist about the appearance of the following symptoms:

• Increased body temperature;
• Severe pain in the place of operative access;
• Increased swelling;
• The presence of numbness or tingling;
• Blueing of the limb or appearance of brown spots;
• The appearance of shortness of breath, nausea, vomiting.

Disability

Arthrodesis of the ankle, a disability after which is considered a rare condition, requires increased training of the patient with a foot from the patient. At small terms after the intervention, disability is possible, but only until the functional condition of the joint is restored.

According to the rules approved by the order of the Ministry of Labor, the operation on involuntary immobilization of the ankle joint in most cases leads to minor violations of static-dynamic functional characteristics, and therefore disability is not established.

By order, disability is confirmed by the percentage of the disease state and the ratio of pathology to the specific list of diseases listed. At the level of pathology up to 30% (estimated by the experts of the commission of the Ministry of Health) the disability is not established, 40-60% is the third group, 70-80% is the second group, 90-100% is the first group. The child receives a disability at rates from 40 to 100%.

Minor changes in which a person is able to self-serve do not belong to the above categories. In the case of development of contracture and violations of the supportive-static functions that caused arthrodesis of the ankle, the consequences are disability, the inability to self-service and satisfy the needs, the development against this background of psychological problems.

Patient Reviews

According to those who survived the operation to immobilize the joint, this is a long complicated surgical manipulation, which requires high qualification of the surgeon. In the rehabilitation period, the important point is that patients begin to feel sorry for themselves and are not working out in terms of performing daily physical exercises. It is these defects that become the key link in the development of joint contractures and motor function disorders.

Lack of pain even in the state of significant loads, complete recovery of gait, no discomfort in the zone of intervention, good cosmetic appearance - indicators of a successful operation.