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Arthrodesis of Foot and Ankle by Ricker Polsdorfer, MD

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Arthrodesis fuses (welds) together the two bones that form a joint. There is no longer movement in the joint after the procedure. One or more related joints may be done at the same time.

Arthrodesis of Foot and Ankle

Reasons for Procedure

Ankle arthrodesis is done to relieve disabling ankle pain or deformity caused by poorly healed fractures, arthritis, infections, or developmental defects.

Although some joints (for example hips and knees) can be replaced with artificial devices, the ankle usually does better with arthrodesis than with joint replacement.

Satisfactory results including good pain relief are achieved in most patients. Most can wear ordinary shoes. Some will benefit from specially fitted footwear.

Possible Complications

Complications are rare but no procedure is completely free of risk. If you are planning to have arthrodesis, your doctor will review a list of possible complications which may include:

Failure of the joint to solidify
Poor alignment of the joint, causing pain and/or an altered gait
Need for repeat surgery
Infection
Bleeding
Nerve damage

Factors that may increase the risk of complications include:

Smoking
Infection
Some chronic diseases

What to Expect

Prior to Procedure

Several nonsurgical methods will be tried to correct your problem before choosing surgery. These may include medications, injections, special shoes, or types of physical therapy. You will have a thorough evaluation to determine your overall health and any risk factors.

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:

Aspirin or other anti-inflammatory drugs
Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

Arrange for help at home after returning from the hospital.

Anesthesia

Your doctor may choose:

General anesthesia—you will be asleep
Spinal anesthesia—anesthesia will be given directly to the spine, your lower body will be numb

Description of the Procedure

There are two different techniques that may be used:

An open procedure uses a long incision and direct visualization of the joint.
Arthroscopic surgery uses tiny incisions. A thin arthroscope with a tiny camera attached to a television will be inserted through one of the incisions. Other thin instruments will inserted into the joint through the tiny incisions also to perform the surgery.

The orthopedic surgeon will select the technique depending upon his experience and your particular anatomy. There are many ways to secure the two bones together so that they no longer move in relation to one another. Long screws, screws and steel plates, long steel rods, and bone grafts have all been used.

You will have a tourniquet strapped around your thigh to shut off circulation so that the surgery can be performed in a bloodless field. Your leg will suffer no ill effects from the tourniquet.

Immediately After Procedure

Your lower leg will be in a rigid cast and elevated after surgery. You will be offered pain medication.

How Long Will It Take?

About 2-5 hours

How Much Will It Hurt?

There will be no pain during the procedure. Afterwards there will be some discomfort. Talk to your doctor about medication to help manage discomfort.

Average Hospital Stay

Barring complications, you may be able to go home in 2-4 days.

Postoperative Care

It will take up to four months to heal and solidly fuse the joint(s). During that time you will be in a cast.

After the procedure, be sure to follow your doctor's instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Bleeding or discharge from your incision(s). This may show up as staining of your cast.
Signs of infection including fever and chills
Increasing or severe pain that is not relieved by your pain medication
Cough, shortness of breath, chest pain, or severe nausea and vomiting
Numbness, tingling, or discoloration in the foot
Any other concerns

In case of an emergency call 911.

RESOURCES:

Penn State Milton S. Hershey Medical Center http://www.hmc.psu.edu/
University of Washington School of Medicine http://www.orthop.washington.edu/

CANADIAN RESOURCES:

Canadian Orthopaedic Association http://www.coa-aco.org/
The University of British Columbia Department of Orthopaedics http://www.orthosurgery.ubc.ca/

References:

Ankle arthrodesis. Journal of the Southern Orthopaedic Association . Orthopaedic Care.net website. Available at: http://orthopaediccare.net/view/templates/Reference_List.asp?chapterid=Foo2903660 . Accessed September 8, 2005.
Daniels TR. Ankle arthrodesis. Canadian Orthopaedic Association website. Available at: http://www.coa-aco.org/_COFAS/Library/Ankle_Arthodesis.html . Accessed September 8, 2005.

Last reviewed October 2009 by John C. Keel, MD and Brian P. Randall, MD

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