28725 Arthrodesis; subtalar

Name of the Procedure:

Arthrodesis; subtalar
Common names: Subtalar fusion, Subtalar joint arthrodesis

Summary

Arthrodesis of the subtalar joint is a surgical procedure designed to fuse the bones in the subtalar joint in the foot. This joint is located below the ankle and helps facilitate foot motion. The fusion aims to eliminate movement and alleviate pain caused by arthritis or injury.

Purpose

Medical Condition or Problem: This procedure addresses severe arthritis, deformities, or injuries affecting the subtalar joint.
Goals or Expected Outcomes: The primary goal is to relieve pain and restore stability to the foot by fusing the bones in the subtalar joint into one solid bone. It also aims to improve foot alignment and functionality.

Indications

Specific Symptoms or Conditions:

• Chronic subtalar joint pain not responsive to conservative treatments.
• Degenerative or post-traumatic arthritis.
• Severe deformities in the subtalar joint causing functional impairments.

Patient Criteria:

• Patients with chronic, debilitating foot pain affecting quality of life.
• Those who have tried non-surgical treatments without success.
• Patients with significant joint instability or deformity.

Preparation

Pre-procedure Instructions:

• Patients may need to fast for at least 8 hours before surgery.

• Medication adjustments, such as stopping blood thinners.

  Diagnostic Tests:

• X-rays or MRI scans to assess the condition of the subtalar joint.
• Blood tests and a full medical evaluation to determine fitness for surgery.

Procedure Description

1. Anesthesia: The procedure is typically performed under general anesthesia or regional anesthesia (nerve block).
2. Incision: A surgical incision is made over the subtalar joint.
3. Bone Prep: The surgeon removes any remaining cartilage from the surfaces to be fused.
4. Alignment: The bones are aligned into the correct position.
5. Fusion: The bones are fixed together using screws, plates, or rods to hold them in place.
6. Closure: The incision is closed with sutures or staples, and a splint or cast is applied.

Duration

The procedure typically takes between 90 minutes to 2 hours.

Setting

The surgery is performed in a hospital or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common Risks:

• Infection
• Blood clots
• Nerve damage

Rare Risks:

• Non-union or delayed union of the bones
• Hardware issues (e.g., loosening of screws or plates)
• Persistent pain post-surgery

Complication Management:

• Antibiotics for infection
• Physical therapy and follow-up imaging for healing assessment
• Possible revision surgery for hardware problems or non-union

Benefits

• Significant pain relief
• Increased foot stability
• Improved walking ability and quality of life
• Outcome improvements typically realized within several months post-surgery

Recovery

Post-procedure Care:

• Limited weight-bearing with crutches or a walker.
• Elevation and icing to reduce swelling.
• Regular follow-up appointments for monitoring.

Expected Recovery Time:

• Initial healing usually takes about 6-8 weeks.
• Full recovery and fusion typically occur within 6-12 months.

Restrictions:

• Avoid weight-bearing activities until the surgeon indicates it’s safe.
• Gradual return to normal activities as advised by the healthcare team.

Alternatives

• Medications for pain and inflammation
• Physical therapy and orthotics
• Ankle braces or supports
• Other surgical options like joint replacement or less invasive procedures

Pros and Cons:

• Medications: Non-invasive but may not provide lasting relief.
• Physical Therapy: Helps with mobility but may not address severe pain.
• Other Surgeries: May have different risks and recovery profiles compared to fusion.

Patient Experience

During the Procedure: Patient will be under anesthesia and will not feel any pain during the surgery.

After the Procedure:

• Initial discomfort managed with pain medications.
• Possible soreness and swelling.
• Follow pain management and physical therapy plans as directed for optimal recovery and comfort.