Arthrodesis, midtarsal or tarsometatarsal, single joint
CPT4 code
Name of the Procedure:
Arthrodesis, midtarsal or tarsometatarsal, single joint
Common name: Midfoot Fusion
Technical term: Tarsal Arthrodesis
Summary
Arthrodesis, or joint fusion, is a surgical procedure where two bones in the midfoot are permanently joined together. This helps to stabilize the joint, alleviating pain and improving function.
Purpose
This procedure is used to treat severe arthritis, deformities, or instability in the midfoot. The goal is to eliminate pain, correct deformity, and restore normal function by fusing the affected bones into one continuous bone.
Indications
- Severe arthritis in the midfoot or tarsometatarsal joints
- Persistent pain unresponsive to conservative treatments
- Deformities or instability of the midfoot
- Traumatic injury or fractures that have not healed properly
Preparation
- Pre-operative consultations and physical examination
- Diagnostic imaging (X-rays, MRI, or CT scans)
- Blood tests and medical clearance
- Fasting typically required 8-12 hours before surgery
- Adjustments or discontinuation of certain medications (e.g., blood thinners)
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: A surgical incision is made over the affected joint.
- Bone Preparation: Damaged cartilage is removed from the joint surfaces.
- Positioning: The bones are positioned in an optimal alignment.
- Fixation: Metal screws, plates, or pins are used to hold the bones together.
- Closure: The incision is closed with sutures or staples, and a dressing is applied.
Duration
The procedure typically takes 1 to 2 hours.
Setting
This procedure is usually performed in a hospital or surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist or nurse anesthetist
- Surgical nurses
- Operating room technician
Risks and Complications
- Infection
- Blood clots
- Nonunion (failure of bones to fuse)
- Nerve damage
- Persistent pain
- Hardware problems (e.g., screws or plates becoming loose or broken)
Benefits
- Significant pain relief
- Increased stability and foot function
- Correction of deformity
- Improved quality of life
- Benefits can often be realized within several months post-surgery following rehabilitation.
Recovery
- Initial immobilization with a cast or boot
- Limited weight-bearing activities for 6-12 weeks
- Physical therapy to restore strength and mobility
- Follow-up appointments for X-rays and progress assessment
- Full recovery may take up to 6 months to a year
Alternatives
- Conservative management (medications, orthotics, physical therapy)
- Joint injections (corticosteroids)
- Other surgical options such as joint replacement or osteotomy
- Each alternative has varying levels of risk and potential effectiveness.
Patient Experience
- Intraoperative: No pain due to anesthesia.
- Postoperative: Pain and swelling managed with medication, elevation, and ice.
- Initial discomfort from immobilization and limited weight-bearing.
- Gradual improvement as the joint heals and physical therapy progresses.