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What is Arthroscopic Ankle Arthrodesis?

Arthroscopic ankle arthrodesis is a surgical procedure to treat severe foot and ankle arthritis that has not responded to non-operative treatments. It is performed using an arthroscope and involves fusion of bones that make up your ankle joint into one unit. The bones in the ankle joint include the tibia, talus, and fibula. The arthroscope is a flexible tube with a light and video camera at the end. The camera projects images of the inside of the ankle joint onto a large monitor, allowing your surgeon to look for any damage, assess the type of injury, and repair the joint.

Picture of Arthroscopic Ankle Arthrodesis

Arthroscopic ankle arthrodesis restricts joint movements and relieves pain in the arthritic joint.

What are the Indications for Arthroscopic Ankle Arthrodesis?

Arthroscopic ankle arthrodesis is considered only after non-surgical approaches like exercise and foot orthotics have failed to treat your end-stage ankle arthritis.

The common recommendations for arthroscopic ankle arthrodesis may include:

  • Post-traumatic osteoarthritis
  • Degenerative osteoarthritis
  • Inflammatory arthropathy
  • Avascular necrosis
  • Ankle instability

Arthroscopic ankle arthrodesis is not recommended for:

  • Active infection
  • Significant foot and ankle deformity
  • Severe bone loss

Pre-Surgical Preparation for Arthroscopic Ankle Arthrodesis

Before scheduling arthroscopic ankle arthrodesis, your doctor examines your ankle joint, overall health condition, and lab reports.

  • You may be asked to get a foot X-ray to understand the extent of damage and plan your surgery.
  • You may be given specific instructions to follow until your surgery.
  • You may have dietary restrictions until your surgery.

You may also be advised to quit smoking, if you do, and perform regular exercise.

Arthroscopic Ankle Arthrodesis Procedure

Arthroscopic ankle arthrodesis involves the following steps:

  • You are placed in a supine position on your back and the foot to be operated upon is elevated at a specific angle to allow better view and ease during the surgery.
  • General or spinal anesthesia may be administered which has a sleep-inducing effect. So you will not wake up or feel any pain during the procedure.
  • One or two small incisions are made in your ankle either from the front (anterior) or side (lateral).
  • The arthroscope is inserted through one of the incisions.
  • Along with it, a sterile solution is pumped into the joint to expand the joint area and create space for your surgeon to operate.
  • The larger image displayed on the video monitor allows your surgeon to visualize the ankle joint and determine the extent of damage.
  • Surgical instruments are inserted through the other incisions.
  • The underlying muscles are carefully separated to expose the ankle joint.
  • Your surgeon removes the damaged cartilage and nearby tissues from the arthritic joint and prepares the bone for fusion.
  • The bones may be fused using screws, rods, wires, or plates.
  • A bone graft may be inserted if you have significant bone loss. This is done using a graft taken from another part of your body (autograft) or from donor tissue (allograft).
  • Your surgeon may also perform additional repairs as needed.
  • In the end, the ankle joint is rotated to check the range of motion.
  • Then, the arthroscope and other surgical instruments are removed.
  • The overlying soft tissues and skin are closed with sutures.
  • Sterile waterproof bandages are applied to keep the surgical site clean and dry.

Post-Surgical Care for Arthroscopic Ankle Arthrodesis

You may be required to stay in the hospital for a night or two or until you can walk comfortably.

  • You will be given medications to minimize post-operative pain, swelling, and discomfort in and around your ankle.
  • Application of ice packs covered with a towel over the operated ankle also helps to reduce postoperative pain and swelling.
  • You are advised to take adequate rest.
  • Ensure minimal weight-bearing during the initial days.
  • You may be told to use a cast, brace, or splint along with orthotic shoes for a specific period to ensure a safe recovery.
  • Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
  • You may begin physical therapy exercises as recommended by your surgeon to improve ankle range of motion.
  • You can return to sports once the foot has regained its normal strength and function, and with your surgeon's approval.
  • You are required to visit your doctor for the first few weeks after the surgery to monitor your recovery.

Complete recovery may take about 4 to 6 months.

What are the Risks and Complications of Arthroscopic Ankle Arthrodesis?

Every surgical procedure carries some amount of risk. Likewise, arthroscopic ankle arthrodesis may also have certain risks and complications. These may include:

  • Anesthesia side effects such as nausea and vomiting
  • Ankle joint deformity or nonunion
  • Infection
  • Deep vein thrombosis: Formation of blood clots in the blood vessels of your leg
  • Revision of fixation
  • Stress fracture

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