Arthrodesis - Nelson

Question 1

Why Arthrodesis?

Answer 1

Surgical immobilization of a joint by fusion of the adjacent bone

Question 2

Indications

Answer 2

• Traumatic or degenerative arthritic changes to a joint
• Malalignment of the foot or ankle -> varus/valgus
• Gross instability of joints
• Congenital/deforming conditions -> CMT/Tarsal coalitions/CP

Question 3

Prep work

Answer 3

• thorough clinical evaluations
• > ROM assessments
• > soft tissue concerns
• > smoking history
• Radiographic Eval
• > position of bones/joints
• > bone stock
• Patient expectation
• Hardware based on procedure

Question 4

What are the 3 goals for anatomical dissection for arthrodesis?

Answer 4

Exposure
Hemostasis
Atraumatic technique

Question 5

Who described the triple arthrodesis?

Answer 5

Edwin Ryerson MD

Question 6

What joints are involved in a triple arthrodesis?

Answer 6

STJ
TN
CC

Question 7

Indications for a triple arthrodesis

Answer 7

valgus foot deformities
PTTD
tarsal coalition
arhtritic conditions
varus foot deformities
neuromuscular deformities

Question 8

Triple arthrodesis concerns

Answer 8

position
approach (lateral, medial, dorsal)
hardware (internal vs external)

Question 9

What are the indications for an STJ athrodesis?

Answer 9

1. End stage articular disease - trauma: calcfractures
2. acquired valgus deformities of the foot
3. symptomatic talcalcaneal coalitions

Question 10

What are the indications for a talo-navicular arthrodesis?

Answer 10

First advocated for children with severe pronation.
Indications:
1. Isolated in adults for RA usually
2. flexible deformities - PTTD
3. Kohler's disease
4. Adjuctive to other procedures

Question 11

Calcaneal-cuboid arthrodesis

Answer 11

Very limited for isolated use

Used to address instability and deformity of the rearfoot-midfoot complex

Question 12

Indications for a calcaneal-cuboid arthrodesis

Answer 12

1. arthritis secondary to certain calcfractures
2. isolated cuboid fractures/ “nutcracker injuiries”
3. transverse planar deformities - “bone block”

Question 13

When would you do an ankle arthrodesis?

Answer 13

Degenerative deterioration of the joint
Instability of the ankle
RA
Charcot
Failed ankle prosthesis
Drop foot
Congenital deformities

Question 14

Ankle arthrodesis techniques

Answer 14

1. Simplest technique - removal of articular cartilage from talus and tibia
2. Anterior bone graft techniques - rarely used
3. Joint resection combined with malleolar osteotomy
4. Bimalleolar approach
5. Compression arthrodesis - external fixator and IM nails

Question 15

Arthroscopic ankle arthrodesis: indication and benefits

Answer 15

Indicated for minimal angular deformities
Benefits:
shorter operative time
less blood loss
far less morbity

Question 16

What is a PanTalar arthrodesis?

Answer 16

Fusion of Ankle, STJ, and Midtarsal joints (can also include the CC joint)
First described by Lorthioir 1911
Option of single vs staged procedures
Indications:
DJD
Gross joint instability (Polio)
Congenital equinovarus deformity

Question 17

What are some adjunctive procedures to keep in mind?

Answer 17

Calcaneal slide
Gatroc-recession
Tenotomies:
TAL
Flexor/extensor lengthenings

Question 18

Post Op Care (*)

Answer 18

Splint application with modified Jones compression
NWB 4-6 weeks
F/U 1 week, 3 weeks, 6 weeks (remove sutrues 3 weeks)
Serial x-rays

Question 19

Complications (*)

Answer 19

Wound dehiscence
Entrapment neuropathy
Pseudoarthrosis/non-union
Chronic pain/RSD

Question 20

Take Homes?

Answer 20

Thorough Work up for patient: surgical planning, hardware
Position, Postion, Position
Patient marriage: complications, post op recovery and pitfalls