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 such a surgical intervention. Its goal is to remove non-viable elements, correct the axis of the lower limb and further fix the anatomical structures in a physiological position. Under what conditions is arthrodesis of the ankle joint performed? What are the consequences of the intervention and the principles of rehabilitation? More on this later in the article.
Indications for surgery
Arthrodesis - 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 junction. It may be partial or complete. The result of deformationthere is a violation of physiological activity inside the joint (prolonged paralysis of muscles, rupture of ligaments, gunshot injury, excessive extension of the joints).
- Development of deforming arthritis. Arthrodesis of the ankle joint, reviews of which can be read below, is required for purulent, traumatic and tuberculous pathology.
- Degenerative arthrosis with complications. Pathological conditions entail changes in the bone epiphyses.
- Complications of polio.
- A fracture that heals incorrectly or has healed in the past.
- If it is necessary to implant part or all of the joint, if other types of interventions are not possible.
Contraindications
Arthrodesis of the ankle joint (negative consequences and complications are very rare after surgery) is prohibited in the following cases:
- until adolescence, while the musculoskeletal system is in the growth stage;
- presence of nontuberculous fistulas caused by the pathological action of atypical mycobacteria;
- presence of infection in the intervention area;
- heavy condition of the patient, lack of stability in dynamics.
After 60 years old, ankle fusion surgery can also cause serious complications.
Types of intervention
There are five main types of operation depending on the course of manipulation and the technique used:
- Intra-articular arthrodesis of the ankle jointperformed by removing the articular cartilage.
- Extra-articular procedure occurs by fastening bone elements with material taken from the body of the same patient. It is possible to use a donor transplant.
- Combined ankle arthrodesis combines both types of surgery. Cartilage is removed from the joint and the bones are fastened with a graft by implanting special metal plates.
- The lengthening type of surgery is based on an artificial fracture. Further, the bone elements are fixed in a physiologically immobilized position and pulled out by the apparatus. In other words, this type of intervention is called "ankle fusion with the Ilizarov apparatus".
- Compression surgery is performed by fixing the elements of the joint using pins, hinges, rods and other specific devices used in traumatology.
Anesthesia used
Local anesthesia is not used for such a surgical intervention 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 an anesthetic sleep by inhalation of special medicines supplied 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 is combined with immersion in a half-asleep state, used for patients who are too suspicious and sensitive.
Arthrodesis of the ankle joint, which patients' reviews indicate that the operation is quite lengthy, can last from 2 to 6 hours. It depends on how severe the primary condition is, on the chosen technique of intervention and the need to use a graft from the same patient.
Patient preparation
Arthrodesis of the ankle joint, which patients' reviews indicate the necessary preoperative preparation, requires a complete examination of the patient. As before any intervention, the operated person must pass clinical tests of blood, urine, biochemistry. Determine the state of coagulation, blood type and Rh factor. Tests for HIV infection, syphilis, hepatitis, x-rays are considered mandatory.
7 days before surgery, you must stop taking drugs that affect the blood coagulation system and non-steroidal anti-inflammatory drugs. On the last day, 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.
Be sure, while the patient is in a hospital, it is necessary to prepare a comfortable atmosphere in the house. You should take care of such things in advance:
- remove slippery rugs;
- place the wires that lie on the floor as compactly as possible so that the patient does not catch on them;
- buy a mat with suction cups in the bathroom so that it does not move on the wet floor;
- place all the necessary devices for hygiene procedures as close as possible so that you do not 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 intervention area is treated with antiseptics and covered with sterile surgical linen.
- 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 brought out 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 against each other, 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 way.
- After a while, 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 operated on
Arthrodesis is not a specific intervention designed specifically for the ankle joint. In the same way, trauma surgeons can immobilizethe following anatomical regions:
- hip joint - the meniscus is excised and the head of the femur is fixed to the pelvic bone, the joint remains completely motionless;
- bone articulation of the knee - allowed only in the absence of pathologies of the cardiovascular system;
- shoulder joint - an intervention in which the bone graft of the patient himself (so that rejection does not occur) or a donor is most often used;
- metassophalangeal 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 are 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 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 pain relief. If necessary, antibacterial drugs are used. This is due to a high risk of suppuration at the location of foreign bodies (pins, plates, rods). Of the antibiotics, preference is given to the least toxic to the patient's body:
- Cephalosporins - "Cefotaxime","Ceftriaxone".
- Macrolides - "Erythromycin", "Clarithromycin".
- Penicillins - Ampicillin, Ampiox.
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 as it was fixed by the specialist. The duration of the plaster can last up to 3-4 months.
The doctor will advise the patient when it is possible to wet the access site. It is impossible to do this on your own in order to prevent infection of the area. After removal of the plaster cast, a second X-ray examination is necessary to confirm the correct union of the bone elements.
The first 2 months it is forbidden to step on the operated leg, so you need to buy 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 the leg and use physiotherapy methods of treatment.
Physiotherapy
Rehabilitation after arthrodesis of the ankle joint involves the inclusion of physiotherapy exercises, massage and other elements in the postoperative stage of recovery. 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 prescribes:
- Electrophoresis - the area of the ankle joint is affectedconstant electrical impulses. With their help, you can administer medications, relieve inflammation, stop pain, eliminate swelling, normalize metabolic processes, and activate blood supply to the surgical area.
- UHF - a procedure in which the effect of an ultra-high frequency electromagnetic field on cells and tissues occurs. UHF promotes the activation of regenerative processes, the healing of fractures and wounds, relieves swelling, eliminates pain, and stimulates local blood circulation.
- Magnetotherapy is a manipulation in which a magnetic field is used. Pain and swelling 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 surface and intraosseous method of exposure, which are part of the treatment and recovery after diseases of the joints.
Arthrodesis of the ankle joint, rehabilitation after which can last up to 8 months, requires the patient to constantly 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
As with any surgical intervention, ankle arthrodesis can have a number of complications:
- infection of the joint with further development of osteomyelitis;
- bleeding, hematoma formation;
- paresthesia -sensory disturbance as a result of dissection of small nerve plexuses;
- lack of joint fixation;
- limping and other pathologies of gait;
- need for additional surgical interventions;
- thrombosis of deep veins of the lower limb;
- thromboembolism of the main arteries.
Be sure to tell the specialist about the following symptoms:
- increased body temperature;
- severe pain at the access site;
- increased puffiness;
- presence of numbness or tingling;
- blue limbs or brown spots;
- appearance of shortness of breath, nausea, vomiting.
Disability
Arthrodesis of the ankle joint, disability after which is considered a rare condition, requires intensive training of the patient's sore leg. 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 the elements of the ankle joint in most cases leads to minor violations of 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 the pathology to the specific list of diseases given. At the level of pathology up to 30%(assessed by specialists of the MSEK commission) disability is not established, 40-60% - the third group, 70-80% - the second group, 90-100% - the first group. A child receives a disability with indicators from 40 to 100%.
Slight changes in which a person is able to take care of himself do not belong to the above categories. In the case of the development of contracture and disorders of the musculoskeletal functions caused by arthrodesis of the ankle joint, the consequences are disability, the inability to independently serve and satisfy needs, and the development of psychological problems against this background.
Patient testimonials
According to those who survived the operation to immobilize the joint, this is a long, complex surgical procedure that requires a highly skilled surgeon. During the rehabilitation period, an important point is that patients begin to feel sorry for themselves and underperform in terms of daily exercise. It is these shortcomings 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 exertion, complete recovery of gait, no discomfort in the intervention area, good cosmetic appearance are indicators of a successful operation.
