Not all pathological conditions of the musculoskeletal system can be eliminated by improving the quality of structural elements. In some cases, blocking the function of one or more segments is required. Arthrodesis of the ankle joint is just such a surgical intervention. Its goal is the removal of non-viable elements, the correction of the axis of the lower limb and the further fixation of the anatomical structures in physiological position. What are the conditions for ankle arthrodesis? What are the consequences of the intervention and the principles of rehabilitation? More about this later in the article.
Indications for the operation
Arthrodesis is an intervention in which the joint is immobilized and fixed artificially in the desired position. The need for surgery is inevitable in the following cases:
- The presence of a dangling joint. This condition occurs against the background of deformation of the interosseous joint. It may be partial or complete. The result of the deformation is a violation of the physiological activity inside the joint (prolonged paralysis of muscles, rupture of ligaments, gunshot injury, excessive extension of the joints).
- The development of deforming arthritis. Arthrodesis of the ankle joint, reviews of which can be read below, is required for a purulent, traumatic and tuberculous form of pathology.
- Degenerative arthrosis with complications. Pathological conditions entail changes in the bone epiphyses.
- Complications of poliomyelitis.
- A fracture that does not grow together correctly or has fused in the past.
- If necessary, the implantation of part or all of the joint, if other types of interventions are impossible.
Contraindications
Arthrodesis of the ankle joint (negative consequences and complications are very rarely observed after surgery) is prohibited in the following cases:
- until adolescence, while the musculoskeletal system is in a growth stage;
- the presence of fistulas of a non-tuberculosis nature caused by the pathological action of atypical mycobacteria;
- the presence of infection in the area of intervention;
- severe condition of the patient, lack of stability in the dynamics.
After 60 years, ankle joint arthrodesis surgery can also cause serious complications.
Types of Intervention
There are five main types of operations, depending on the course of manipulation and the technique used:
- Intra-articular arthrodesis of the ankle joint is performed by removing articular cartilage.
- An extra-articular procedure occurs by bonding 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. Cartilage is removed from the joint and bone graft is carried out by implantation of special metal plates.
- The lengthening type of operation is based on an artificial fracture. Further, the bone elements are fixed in a physiological immobilized position and are stretched by the apparatus. In other words, this type of intervention is called "ankle joint arthrodesis using the Ilizarov apparatus."
- A compression operation is performed by fixing the elements of the joint using knitting needles, hinges, rods and other specific devices used in traumatology.
Applied Anesthesia
Local anesthesia is not used for such surgery due to the fact that the manipulation takes place on deep bone and cartilage structures. The following types of anesthesia are used:
- endotracheal anesthesia - the patient is immersed in anesthetizing sleep by inhalation of special medications given in a 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 is combined with immersion in a state of drowsiness, it is used for patients who are too sensitive and sensitive.
Arthrodesis of the ankle joint, patient reviews of which indicate that the operation is quite long, can last from 2 to 6 hours. It depends on how difficult the initial condition is, on the chosen technique of intervention and the need to use a transplant of the same patient.
Patient preparation
Arthrodesis of the ankle joint, patient reviews of which indicate the necessary preoperative preparation, requires a full examination of the patient. As before any intervention, the operated person must undergo clinical tests of blood, urine, and biochemistry. Determine the state of coagulability, blood type and Rh factor. Tests for HIV infection, syphilis, hepatitis, and x-rays are considered mandatory.
7 days before the operation, it is necessary to abandon drugs that affect the blood coagulation system, and non-steroidal anti-inflammatory drugs. In the last day only light food is allowed. In the morning before the intervention, it is forbidden to eat and drink water in order to avoid possible complications during anesthesia.
It is imperative that while the patient is in a hospital setting, it is necessary to prepare a comfortable atmosphere in the house. Take care of such things in advance:
- remove rugs on which you can slip;
- arrange the wires that lie on the floor as compactly as possible so that the patient does not catch on them;
- in the bathroom, buy a rug with suction cups so that it does not move on the wet floor;
- arrange all the necessary devices for hygiene procedures as close as possible so that you don’t have to reach for them.
Technique
Arthrodesis of the ankle joint after obsolete injuries or infectious processes that led to impaired functional abilities is carried out in several stages:
- The area of intervention is treated with antiseptics and covered with sterile surgical underwear.
- In the projection of the joint, an incision is made up to 15 cm in length. The fascia and muscles are dissected in layers, until the articular surfaces are withdrawn into the wound.
- Cartilage tissue is removed, non-viable and injured elements of the joint are removed.
- The surfaces of the talus and tibia, which will fit snugly together, are formed accordingly. This is done in order to establish the correct axis of the lower limb.
- The resulting structure is fixed with special metal devices in a fixed manner.
- Over time, the bone elements will grow together and the joint will no longer have its original appearance. Its functions will be partially transferred to other elements.
What other joints are operating?
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 - meniscus is excised and the femoral head is fixed to the pelvic bone, the joint remains completely motionless;
- bone joint of the knee - allowed only in the absence of pathologies of the cardiovascular system;
- shoulder joint - an intervention in which the patient’s bone graft is most often used (so that rejection does not occur) or the donor;
- metatarsophalangeal joint - the purpose of the intervention is to eliminate hallux valgus or iatrogenic deformity of the thumb, the joints remain mobile after the recovery period.
The reasons that require arthrodesis of these joints correspond to all of the above.
Recovery period
Arthrodesis of the ankle joint, the photo of which allows you to get a detailed idea of the operation, requires a long recovery. The first day you can’t 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 to relieve pain. If necessary, antibacterial drugs are used. This is associated with a high risk of suppuration at the location of foreign bodies (spokes, plates, rods). Of antibiotics, preference is given to the least toxic to the patient's body:
- Cephalosporins - "Cefotaxime", "Ceftriaxone".
- Macrolides - Erythromycin, Clarithromycin.
- Penicillins - Ampicillin, Ampioks.
For some time after the operation, it is necessary to wear a plaster cast so that the exposed position of the lower limb remains the same in which the specialist fixed it. The duration of use of gypsum can last up to 3-4 months.
The doctor will advise the patient when it is possible to wet the operative access site. You cannot do this on your own in order to prevent infection of the area. After removing the plaster cast, 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 purchase crutches and move only with them. 3 months after the X-ray, with the permission of the trauma surgeon, you can begin to lean on your leg and use physiotherapeutic methods of treatment.
Physiotherapy
Rehabilitation after ankle joint arthrodesis involves the inclusion of physiotherapy exercises, massage and other elements in the postoperative recovery phase. Physical therapy 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 prescribes:
- Electrophoresis - on the ankle joint zone there is an effect of constant electrical impulses. With their help, you can enter medications, relieve inflammation, stop soreness, eliminate swelling, normalize metabolic processes, activate blood supply to the surgical area.
- UHF - a procedure in which the effect of an electromagnetic field of ultrahigh frequency on cells and tissues. UHF helps activate regenerative processes, heal fractures and wounds, relieves swelling, eliminates pain, and stimulates local blood circulation.
- Magnetotherapy is a manipulation in which a magnetic field is used. The pain and edema are eliminated, the possibility of infection of the intervention area is prevented, the elasticity of blood vessels increases and blood circulation in the affected area improves.
- Laser therapy - it is possible to use the superficial and intraosseous method of exposure, which are part of the treatment and recovery from joint diseases.
Arthrodesis of the ankle joint, after which rehabilitation can last up to 8 months, requires constant patient work on himself. Only in this case can the development of complications be avoided and the function of the operated area restored.
Possible complications
Like any surgical intervention, ankle arthrodesis can have a number of complications:
- joint infection with the further development of osteomyelitis;
- bleeding, hematoma formation;
- paresthesia - a violation of sensitivity as a result of dissection of the small nerve plexuses;
- lack of fixation of the joint;
- lameness and other gait pathologies;
- the need for additional surgical interventions;
- thrombosis of the deep veins of the lower limb;
- thromboembolism of the main arteries.
Be sure to tell the specialist about the appearance of the following symptoms:
- increase in body temperature;
- severe pain in the place of operative access;
- increased swelling;
- numbness or tingling;
- blue limb or the appearance of brown spots;
- the appearance of shortness of breath, nausea, vomiting.
Disability
Arthrodesis of the ankle joint, disability after which is considered a rare condition, requires intensive training on a sick leg from the patient. With a short time after the intervention, disability is possible, but only until the restoration of the functional state of the joint.
According to the rules approved by the order of the Ministry of Labor, the operation on the forced immobilization of ankle joint elements in most cases leads to minor violations of the static-dynamic functional features, which means that 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. With a pathology level of up to 30% (estimated by experts of the MSEC Commission), disability is not established, 40-60% are in the third group, 70-80% are in the second group, 90-100% are in the first group. The child receives a disability at rates from 40 to 100%.
Minor changes in which a person is able to self-service themselves do not belong to the above categories. In the case of the development of contracture and violations of the supporting-static functions caused by arthrodesis of the ankle joint, the consequences are disability, the inability to service and satisfy one's own needs, and the development of psychological problems against this background.
Patient Reviews
According to those who survived the operation to immobilize the joint, this is a lengthy complex surgical procedure requiring a highly qualified surgeon. In the rehabilitation period, an 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 such defects that become a key link in the development of joint contractures and impaired motor functions.
The absence of pain even in a state of significant stress, the complete restoration of gait, the absence of discomfort in the intervention area, a good cosmetic appearance are indicators of a successful operation.