Arthrodesis of the ankle in Tunisia
What's this ?
Arthrodesis is what doctors call operations in which they fix the joints with screws, nails or plates. The bones fuse over the course of a few weeks; they stiffen. In the case of the knee, hip and shoulder joints, our orthopedists today only recommend stiffening in absolutely exceptional cases, because we can almost always offer better solutions that maintain more mobility by means of artificial joints (endoprostheses). In the case of the ankle joint and metatarsophalangeal joint, however, arthrodesis is considered a proven method of relieving patients of unbearable pain and restoring joint resilience and stability.
When does arthrodesis help?
In the event of severe joint damage - for example due to osteoarthritis, previous bone damage or rheumatic diseases - the joints become increasingly unstable. Bone rubs against bone in many cases causing unbearable pain.
If there are concrete arguments against a joint prosthesis of the upper ankle or if it has already come off, arthrodesis is the best option to help the patient no longer feel pain or at least to achieve a significant reduction in pain.
Better mobility despite stiffening
The word stiffness frightens many patients at first: on the one hand they are afraid of losing part of their ability to move, and on the other hand the word sounds definitively and negatively in their ears.
Contrary to what most patients suspect in advance, movement restrictions are not severe: Even after ankle stiffening, patients can walk well and play moderate sports.
If the individual ankles stiffen, the restrictions are hardly noticeable - neighboring ankles take over.
The stiffening operation significantly reduces the pain that made the patient suffer a lot. As a result, range of motion increases dramatically and patients can once again work and participate actively in social life - even in jobs that strain their feet.
Before the arthrodesis, most patients felt that their activities were much more limited by the pain than after by the slightly reduced mobility.
The stiffening operation
By means of careful examinations, the extent of joint destruction, possible malpositions and the stability of the surrounding ligaments are recorded in the preparation. In the case of an ankle operation, we always take x-rays of the whole leg in a standing position, so that we can clearly visualize all the axes of the leg. For foot operations, we need standing x-rays to be able to visualize the foot bones under load.
Before planning an arthrodesis, we always take a lot of time to discuss the proposed procedure in detail with the patient.
In order to prepare for the operation, our anesthesiologists generally need a blood count and possibly an ECG (recording of the electrical activity of the heart). Anticoagulant drugs such as Marcumar should be stopped in good time before the operation.
Our anesthesiologists can offer several anesthesia procedures, but generally recommend light general anesthesia combined with local nerve block for ankle operations. This nerve block usually lasts twelve to 20 hours, so the first night after the operation remains almost pain-free.
In the case of arthrodesis of the metatarsophalangeal joint of the big toe, a purely local anesthetic can even be applied to the level of the foot, what doctors call "foot block". However, if patients wish, they can also benefit from a light general anesthetic.
When do we operate in a minimally invasive way, in the open?
Our orthopedists can perform certain ankle arthrodeses in a minimally invasive way, that is to say without major incisions. However, this is not possible in case of malpositions and important bone lesions, in which case it is necessary to operate uncovered in favor of a stable fixation.
"Arthrodesis of the ankle is a demanding operation because it requires precise knowledge of the biomechanics of this complex joint, especially if the bottom of the ankle is also affected"
How long will I stay at the clinic?
After ankle arthrodesis, patients typically stay in our clinic for five to seven days, and after metatarsophalangeal joint fusion, two to three days. We can usually remove the drainage the day after the operation.
We check the wound closely and change the dressing at least every other day. All patients receive pain treatment tailored to their individual pre-existing conditions. We recommend constantly elevating the leg to promote healing.
What happens after the operation?
Since the bones must be kept in a completely stable position so that they can grow together peacefully, a cast is placed after each arthrodesis, which remains in place for about six weeks. After that, patients whose ankle has been fused are given a special shoe.
After the operation of the metatarsophalangeal joint of the big toe, those affected must wear a so-called walker, a special walking splint. Arthrodesis patients can only wear normal shoes again after about three months.
Most patients get along well in everyday life without additional aids. In some cases, however, we recommend shoes with rolling aids after the ankle has been stiffened. Patients whose metatarsophalangeal joint has been stiffened may require insoles and, in rare cases, a special shoe.
Can I do sports again with a joint fusion?
Even after stiffening operations, sports activities are possible: patients can walk normally, but also go hiking, cycling and swimming. Only on rough terrain they may find it a little difficult at first.
However, running sports usually put too much stress on the joints. However, if you have already played tennis, for example, you can resume it after the operation, but you have to reduce your demands a bit.