28705 Arthrodesis; pantalar

Name of the Procedure:

Arthrodesis; pantalar Common name(s): Pantalar fusion

Summary

Arthrodesis of the pantalar joint, or pantalar fusion, is a surgical procedure that fuses the bones in the ankle and hindfoot together, eliminating motion in these joints to reduce pain and stabilize the foot.

Purpose

Conditions Treated:

• Severe arthritis
• Post-traumatic arthritis
• Foot deformities
• Chronic instability or pain in the ankle and hindfoot

Goals:

• Alleviate intractable pain
• Correct deformities
• Improve foot stability and ability to bear weight

Indications

• Severe, debilitating pain unresponsive to conservative treatment
• Significant deformities affecting function or footwear
• Chronic instability despite other interventions
• Failed previous surgeries to correct the condition

Preparation

• Fasting typically required for 6-8 hours before the procedure
• Pause on certain medications as advised by the doctor
• Preoperative assessment including imaging (X-rays, MRI)
• Blood tests and a complete health evaluation

Procedure Description

1. Anesthesia: General anesthesia or spinal anesthesia is administered.
2. Incisions: Surgical cuts are made to access the ankle and hindfoot joints.
3. Bone Preparation: Cartilage is removed from joint surfaces to enable bone fusion.
4. Bone Grafting: Bone grafts (often harvested from the patient’s pelvis or donor bone) may be placed to enhance fusion.
5. Fixation: Bones are aligned and fixed together using screws, plates, or rods.
6. Closure: Incisions are closed with sutures or surgical staples.
7. Immobilization: The foot and ankle are immobilized in a cast or splint.

Duration

Typically, the procedure takes 2 to 3 hours.

Setting

Performed in a hospital surgical suite.

Personnel

• Orthopedic Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

• Infection
• Nonunion or delayed bone healing
• Blood clots
• Nerve damage
• Persistent pain or discomfort
• Hardware-related issues (e.g., loosening, breakage)

Benefits

• Significant pain relief
• Improved foot function and stability
• Enhanced quality of life and mobility
• Long-term solution with reduced likelihood of future surgeries

Recovery

• Hospital stay of 1 to 3 days
• Foot immobilization for several weeks
• Use of crutches or a walker to avoid weight-bearing on the foot
• Physical therapy for rehabilitation
• Full recovery may take 6-12 months
• Regular follow-up appointments to monitor healing

Alternatives

• Non-surgical treatments (e.g., medication, physical therapy, orthotics)
• Arthroscopy (minimally invasive surgery)
• Joint replacement (ankle arthroplasty)

Pros and Cons of Alternatives:

• Non-surgical: Less invasive but may not provide sufficient relief for severe cases.
• Arthroscopy: Minimal incisions but may only temporarily alleviate symptoms.
• Joint Replacement: Preserves joint movement but may have a limited lifespan and potential for revision surgery.

Patient Experience

• During the Procedure: Sedated with little to no awareness.
• Post-procedure: Initial pain managed with medications, followed by a period of discomfort as healing progresses.
• Pain Management: Adequate pain relief with prescribed analgesics.
• Comfort Measures: Rest, elevation, ice, and compression to reduce swelling and pain.