What is a triple arthrodesis surgery?

A triple arthrodesis is a surgical procedure that fuses three joints of the ankle and relieves pain from arthritis.
A triple arthrodesis is a surgical procedure that fuses three joints of the ankle and relieves pain from arthritis.

A triple arthrodesis is a surgical procedure that fuses three joints of the ankle. It is used to relieve pain from arthritic, deformed, or unstable joints. 

Generally, surgeons try to avoid the fusion procedure by treating the ankle joints with alternative methods. However, when the pain is so severe, a triple arthrodesis remains the only option. 

Most of the time, a triple arthrodesis offers satisfactory results in the long term as well. In one study that followed patients for 44 years after their triple arthrodesis, it found that 95% of patients were satisfied with the outcome.

Why is a triple arthrodesis performed?

A triple arthrodesis is performed for patients with the following conditions:

  • Rheumatoid/degenerative arthritis (severe arthritis of ankle)
  • Ankle deformity
  • Ankle instability 
  • Severe flatfoot
  • Abnormal connections between bones
  • Excessively high arches
  • Joint instability due to neuromuscular disease such as poliomyelitis

Many of these conditions may be treated using other procedures. Only when the nonsurgical treatments fail, the surgeon considers a triple arthrodesis. After examining the patient’s condition and disease progression, the surgeon decides whether to perform a triple arthrodesis.

What is done before a triple arthrodesis?

Two to three X-rays of each foot will be taken from different angles to understand the ankle problem and how to go about the surgery.

The patient will be admitted the night before the surgery and asked not to eat or drink anything for the next 12 hours before the surgery.

What is the technique used in a triple arthrodesis?

A triple arthrodesis is performed by an orthopedic surgeon.

  • The patient might be given general anesthesia that makes them sleep throughout the procedure or spinal anesthesia that numbs their entire leg. Additionally, an injection in the back of the knee or ankle joint may also be given to ease the pain.
  • Next, the orthopedic surgeon makes one incision (cut) on each side of the foot.
  • Further, the surgeon removes the elastic structure over the joint surfaces (cartilage), followed by the roughening of the bony surfaces and filling of the bony defects with bone grafts.
  • Next, the surgeon attaches the bones with the help of hardware such as screws. This will eventually result in healthy fusion.
  • The surgeon then sutures the incisions and covers the surgical wound with a bandage.

What is done after a triple arthrodesis?

  • The patient is observed for several hours after the surgery.
  • Analgesics are given, and the leg is elevated to reduce the postoperative edema and pain in the ankle.
  • The patient is discharged after one to three days. Instructions are given about which activities need to be restricted.
  • While at home, leg elevation should be continued for the next five days, and ice should be applied over the ankle around three to four times a day.
  • The patient should visit the hospital after one week to change the wound dressing.
  • A short leg cast is applied after the edema has disappeared to restrict the movements in the ankle joint and allow healthy fusion of the joints. 
  • Sutures are removed after two weeks.

SLIDESHOW

Rheumatoid Arthritis (RA) Symptoms & Treatment See Slideshow

What are the complications of a triple arthrodesis surgery?

  • Nonunion/malunion (bones may not fuse, or they may fuse abnormally)
  • Degenerative joint disease (ankle arthritis due to wearing of the surrounding structures)
  • Delayed wound healing
  • Nerve injury
  • Avascular necrosis (Damage to the adjacent blood vessels leading to the destruction of the ankle bone)
  • Lateral instability (inability to move the ankle sideways) 
  • Stiff foot

How long does it take to recover from a triple arthrodesis?

  • The patient wears a plaster cast, wrapped around the ankle and foot, for the first 12 weeks following the surgery. Crutches can be used to move around and avoid weight bearing on the ankle.
  • Gradual weight bearing is allowed until full weight bearing is reached. This usually takes around three months. The cast is removed and replaced by a removable walker boot.
  • X-rays are obtained at approximately 12 weeks. If stable fusion is observed, the patient can switch from the walker boot to normal shoes.
  • Physical therapy is required to restore strength and mobility in the ankle joint.
  • It usually takes around ten 10 months to become pain-free and recover from the surgery.
  • The patient can experience maximum improvement one year after the surgery.

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Medically Reviewed on 7/31/2020
References
"Triple arthrodesis"

Medscape Medical Reference
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