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Surgery for osteoarthritis of the ankle and osteoarthritis of the foot

Julien Lopez is an orthopaedic surgeon specialising in ankle osteoarthritis surgery, and operates in in Nice near Monaco, Antibes, Cannes and Saint-Raphael.

Surgery for osteoarthritis of the ankles and feet? Why not! But first, let's try to understand what osteoarthritis is?

Before explaining how to operate on osteoarthritis of the ankles and feet, let us take the time to explain what osteoarthritis is and what it corresponds to.

Osteoarthritis is the wear and tear of the cartilage of a joint. It is often called osteoarthritis.The ankle, for example, is the joint located between the leg and the foot (between the tibia and the talus) which allows movements of plantar or dorsal flexion (extension). In a joint, the bones slide together thanks to a coating called "cartilage": it is white and smooth like a hard-boiled egg. When the cartilage deteriorates, it is called arthrosis.

ankle osteoarthritis gif

Why does it happen and what are the aggravating factors?

In most cases, no cause is found: this is called "primitive" osteoarthritis. Several hundred steps are taken every day and it is easy to understand that cartilage will tend to deteriorate over time, like any mechanical structure. It is the natural ageing of the human body that is expressed. Osteoarthritis mainly affects patients over the age of 50. This wear and tear is accelerated in the case of problems with the leg axes or foot deformities such as flat feet or hollow feet.

On the other hand, when osteoarthritis is caused by a known cause, it is called "secondary" osteoarthritis. Examples include trauma such as ankle fractures or sprains (this is called post-traumatic osteoarthritis) or inflammatory diseases such as rheumatoid arthritis. In rheumatoid arthritis, the mechanism of destruction of the cartilage is not mechanical but inflammatory: we speak of ankle arthritis. We can also talk about the sports patient in whom repeated microtrauma favours the development of osteoarthritis.

The symptoms of osteoarthritis of the foot or ankle

The signs of ankle arthrosis are pain, stiffness and swelling. It leads to a functional impact, mainly pain and limitation of the walking perimeter, which can go as far as a limp or the use of a cane. The pain is said to be mechanical, i.e. it is expressed each time the foot is used, such as when walking, running, going up or down stairs, cycling and sometimes when moving from a sitting to a standing position. Stiffness is the decrease in the mobility of a joint. Ankle flexion becomes limited. The pain is often accompanied by swelling due to a joint effusion (synovial effusion) that is often associated. In rare cases, joint blockages or pseudo-blockages and cracking may occur.

These symptoms generally appear slowly in the case of primary osteoarthritis, but they can also occur in an acute form, in which case they are referred to as osteoarthritis flare-ups or acute attacks. In the case of secondary osteoarthritis, such as post-traumatic osteoarthritis, the symptoms may appear several years after the trauma and develop rapidly.

It requires a consultation with a specialist surgeon and an imaging assessment including standard X-rays. These examinations make it possible to specify the affected joint and the degree of osteoarthritis. Sometimes, it is useful to carry out other examinations such as an MRI to look for associated lesions.

In conclusion, as with all the other joints of the foot, ankle osteoarthritis is mainly manifested by pain when walking or playing sports.

How is it evolving?

If osteoarthritis of the ankle is not treated, the cartilage becomes increasingly damaged and the osteoarthritis gradually worsens. Activities decrease, the walking perimeter becomes limited, pain and functional discomfort increase, sometimes forcing patients to use a cane when walking.

How to prevent osteoarthritis and its aggravation?

There is no cure for ankle osteoarthritis. On the other hand, it is possible to limit the aggravation by adapting one's lifestyle and by respecting certain simple instructions:

If you are overweight, it is recommended that you lose weight to limit excess weight. The joints of the foot work under load, any excess weight will result in excessive stress in the joints with an increased risk of osteoarthritis and pain.

In the presence of proven osteoarthritis, joint economy should be favoured. Joint economy consists of reducing the stress on damaged joints by adapting sports or professional activities.

Physical activity in the gym, at home or with a physiotherapist is good for your body and your joints. Flexibility can also be worked on during yoga or pilates sessions. A flexible and muscular ankle will be better protected from arthritis.

If you are hiking or walking, choose tight fitting shoes that hold the ankle properly.

How to treat and relieve ankle osteoarthritis without surgery?

During the consultation, the surgeon will look for the different symptoms of osteoarthritis and will specify your habits. He will evaluate the functional impact of your symptoms on your daily and leisure activities. He will then proceed with an examination to define the site of the affected joint, the joint mobility or the presence of risk factors such as axis deformations. The surgeon then prescribes an imaging assessment to objectify the diagnosis and evaluate the stage of the osteoarthritis. The 4 radiographic signs of osteoarthritis are :

  • Joint pinching: this is the reduction in the height of the joint space due to wear of the cartilage.
  • Osteophytes are bone formations around the diseased joint. They serve to protect the degradation of the cartilage by limiting mobility (stiffness) but can sometimes become the cause of pain.
  • Geodes are "holes" in the bone.
  • Subchondral condensation is seen as a whitish appearance under the joint space. It indicates a mechanical overload of the joint.

Concerning osteoarthritis of the ankle and foot, the treatment is always medical in the first instance. Before considering an operation for osteoarthritis of the foot, we start with a non-operative treatment. The aim is to reduce the pain, but this does not prevent the osteoarthritis from progressing.

Medical treatment offers several possibilities:

  • Manufacture of orthopaedic insoles made to measure by the podiatrist: they allow for cushioning, a better distribution of support or to correct an axis defect
  • Infiltrations: these are injections of oil (visco-supplementation) or anti-inflammatory drugs (alone or combined) into the ankle
  • Adaptation of the physical activity and the sport practice: we will favour sports that are less demanding for the ankle
  • Adaptation of the shoes: favour those which offer a good support for the ankle (mountain shoes for example)
  • Painkillers and/or anti-inflammatory drugs: they can be prescribed in case of a painful crisis
  • Physiotherapy: helps to maintain the flexibility of the foot
  • Weight loss in case of overweight

Surgery for osteoarthritis in general: How is it done? When should the operation be performed? What does the surgeon do? We explain it all to you …

When medical treatment is no longer effective and functional discomfort is significant, surgery for osteoarthritis of the ankle or other joints may be proposed. The surgical principle depends on the level of functional demand (level of activity), the age of the patient, and the affected joint and its degree of damage. The objective of the surgical treatment is to make the pain disappear, to have a foot or ankle that is fit and centered compatible with your functional desires.

Hospitalization

The procedure is usually performed on an outpatient basis (one day's hospitalization) or inpatient depending on the type of procedure performed.

Anesthesia

  • You will have to undergo the obligatory pre-anaesthetic consultation with the anaesthetist. During this consultation, the anaesthetist will explain the possible modes of anaesthesia according to your associated pathologies and the planned operation. If necessary, he will adapt your treatment before and after the operation and may prescribe anticoagulants, painkillers, anti-inflammatory drugs or others.
  • Several types of anaesthesia are possible: you can benefit from a local or local anaesthesia meaning that only your leg will be desensitised: this is the most frequent. General anaesthesia is also a solution if you prefer to be asleep.

Intervention:

  • Before the operation for osteoarthritis of the foot or ankle: you will be placed on a bed and taken to the pre-anaesthesia room. If necessary, a local anaesthetic will be given before you enter the operating room.
  • The position on the operating table depends on the type of surgery performed. You can be placed on your side or on your back in case of ankle prosthesis
  • Tourniquet: Throughout the procedure, a tourniquet is usually placed around the ankle or thigh to prevent bleeding.
  • The incision: The size of the incision varies with the location of the affected joint and the surgical technique used by the surgeon. With arthroscopic techniques, the incisions measure a few millimetres. The surgeon works through small "holes" by introducing a camera and instruments. The so-called "open technique" requires an incision of several centimeters.
  • The surgical procedure: The surgical procedure also varies with the joint affected and the stage of the osteoarthritis. We can generally describe different types of surgical treatment in osteoarthritis:
  • Arthroscopy is performed in the early stages of osteoarthritis and when the joint is accessible. It allows joint debridement, removal of bone or tissue conflicts, joint cleaning and removal of foreign bodies or inflammatory tissue.
  • Arthrodesis consists of removing the joint by fusing the 2 diseased bones in order to permanently eliminate the pain. The diseased cartilage is removed and the joint is fixed with material (screws, plates, staples) while waiting for consolidation. The main disadvantage is the loss of mobility of the affected joint. All joints can be arthrodesed.
  • The joint prosthesis (total ankle prosthesis or TAP) or arthroplasty concerns only the ankle. The damaged joint is replaced by an ankle prosthesis. Ankle prosthesis surgery requires a strict selection of patients and allows to preserve joint mobility.
  • Osteotomies consist in making bone fractures in order to modify the axes and cartilage constraints. Performed mainly on the tibia, they help to slow down the worsening of osteoarthritis for about ten years.
  • Operating time: the duration of the surgical procedure is usually 30 minutes to 3 hours. The operation can be longer in case of associated gestures or operative difficulties.
  • The material: in most cases, the surgical procedures require the placement of implants such as prostheses, screws, plates, pins or wires. Some materials can be removed afterwards.
  • At the end of the operation: the surgeon dresses and immobilizes the limb if necessary.

It is important to note that the surgeon may be faced with an unforeseen or unusual situation requiring different procedures than those initially planned. In this case, the surgeon will explain to you the difficulties encountered and the procedures performed as soon as you wake up or return to your room.

What are the after-effects of the operation?

Let's explain a little about the aftermath of surgery for osteoarthritis of the ankle or osteoarthritis of the foot.

In conclusion

The postoperative period depends on the surgery performed. They will be quick in the case of a simple arthroscopic debridement or an ankle prosthesis. In the case of arthrodesis, the after-effects are longer with a period of non-weight-bearing that can go up to 2 months. The surgeon and the anaesthetist will give you details during the pre-operative consultations.

Focus on surgery osteoarthritis of the ankle

Several types of surgical procedures are possible during ankle osteoarthritis surgery. A distinction is made between those that preserve the ankle joint, known as "conservative treatment", such as osteotomies. Then there are the "non-conservative" procedures, i.e. the joint is not preserved, as in arthrodesis or total ankle prosthesis.

Important: Even though ankle prosthesis is classified as a "non-conservative" treatment, it has the advantage of preserving joint movement unlike ankle arthrodesis (permanent locking).

1) Conservation of the ankle: osteotomies

This solution is possible when the ankle is not badly damaged and there is still enough healthy cartilage to function. Osteotomies are fractures made in the tibia or calcaneus to correct axis problems. This correction allows the stresses of the healthy cartilage to be transferred to the diseased cartilage and protects it from joint degradation. This slows down the evolution of osteoarthritis while maintaining the mobility of the ankle. This makes it possible to postpone the deadline for a more radical solution (arthrodesis or prosthesis) by 10 years on average.

These operations often require the implantation of surgical material (prosthesis, plates, screws, pins…) to maintain the bone in position while waiting for its consolidation. Most often a drain is put in place for a few days to avoid a hematoma. As soon as the patient leaves the operating room,the limb is immobilized in a boot. Support is forbidden or limited in most cases, this limitation can go up to 6 weeks as in the case of an osteotomy of the tibia. After this period, you can gradually walk again and leave the boot. The surgeon may prescribe crutches, a walker or a wheelchair depending on the situation.

2) Sacrifice of the ankle: arthrodesis

The principle: Arthrodesis is a fusion of the joint obtained by surgery. It is the procedure most often carried out when the stage of conservative treatment is exceeded. It is a definitive and long-lasting solution that eliminates joint pain. However, it leads to a loss of mobility of the ankle and movements of flexion and extension.

foot radiography with surgical material to maintain the bone

Surgery: In practice, the surgeon can perform the ankle arthrodesis under arthroscopy (making skin flecks) or open surgery (10cm incision). The surgeon removes the remaining damaged cartilage and then fixes the whole in the desired position. These operations often require the implantation of surgical material (plates, screws, pins…) to maintain the bone in position while waiting for its consolidation (bone fusion). This material can be kept if it is not troublesome. Most often a drain is put in place for a few days to avoid a hematoma.

Walking: As soon as the patient leaves the operating room,the limb is immobilized in a boot. Walking is forbidden or limited in most cases, this limitation can go up to 8 weeks. After this period, you can gradually walk again and leave the boot. The surgeon may prescribe crutches, a walker or a wheelchair.

Consequences, advantages and risks:The main disadvantage remains the loss of mobility of the ankle. The joint blockage leads to a mechanical overload of the neighbouring joints with a risk of arthrosis and pain. It is frequent to observe, 10 years after the surgery, are curvatum of the knee or an osteoarthritis of the torsion torque. The advantage of this operation is that it is definitive and does not require repeat surgery as in the case of an ankle prosthesis (except for the removal of the material). The main risk (or complication) of this surgical technique is non-union (non-fusion or pseudo arthrodesis of the ankle). The diagnosis of pseudarthrosis made if bone fusion has not occurred after 6 months. It requires a surgical revision with sometimes a bone graft.

Walking: Walking after an ankle arthrodesis is possible without limping in most cases. However, it requires several weeks or months of rehabilitation and healthy joints (knee and hip). Your brain has to get used to your new walking pattern and this takes time. Wearing high heels after ankle arthrodesis is no longer possible because your ankle will not be able to adapt to the slope. However, it is possible to walk with a heel of 2 or 3 cm. It is imperative to inform your surgeon so that he can adjust the ankle to a position compatible with your lifestyle.

Sport: Sport after ankle arthrodesis is possible if the rest of the foot and the overlying joints (knee and hip) are healthy. You can practice any sport you wish. Running or sports that require fast starts can be difficult. Cycling, swimming and walking are sports that should be resumed as a matter of priority as they actively contribute to your rehabilitation. If you are a walker, consider investing in good hiking boots.

3) Sacrifice of the ankle: the total ankle prosthesis

The principle : The operation consists in replacing the 2 sides of the ankle joint (tibia and talus) with a prosthetic joint implant or prosthesis. It is composed of 3 elements:

Total ankle prosthesis is an excellent alternative to arthrodesis provided that patients are carefully selected. In contrast to ankle arthrodesis, the prosthesis allows the preservation of movement and function, preserves the cartilage of the surrounding joints and improves the walking pattern.

Before the appearance of the latest generation of prostheses, prosthetic surgery of the ankle was associated with a high rate of failure and revision surgery. These failures can be attributed to insufficient quality of fitting and to the design of the prostheses which did not respect the biomechanics of the foot (ligaments, bone shape and neighbouring joints such as the subtalar). Today, with the arrival of the latest generation of prostheses and in particular the custom-made cutting guides, ankle prosthesis surgery has become reliable and reproducible, the only guarantee of a lasting result. It remains a technical surgical procedure that requires a long learning curve.

Indication

A rigorous selection of patients is essential before the installation of a total ankle prosthesis, it is the guarantee of a good result in the medium and long term.

In the presence of proven ankle arthrosis, total ankle prosthesis and arthrodesis are discussed. As mentioned above, ankle arthrodesis is a definitive solution, but it has the major disadvantage of leading over the years, in addition to the immediate risk of non-union (pseudarthrosis non-fusion), to arthritic decompensation of the neighbouring joints (knee, subtalar, leopard, etc.).

On the contrary, the total ankle prosthesis (TAP) allows, by preserving the mobility of the ankle, to preserve a more physiological walking pattern. TAP also prevents the degradation of adjacent joints. Thus, in the presence of osteoarthritis of the neighbouring joints, TAP is a good alternative.

In the presence of inflammatory arthritis such as inflammatory polyarthritis, total ankle prosthesis should also be preferred. Arthrodesis risks accelerating the degradation of the already suffering neighbouring joints.

In the presence of classic ankle osteoarthritis, a distinction must be made between primary osteoarthritis (without a known cause), which is very rare, and secondary osteoarthritis, which often occurs following a trauma (post-traumatic osteoarthritis). In these cases, CTP can be considered if the ankle is centred and stable.

There are multiple contraindications to the implantation of a total ankle prosthesis:

When the conditions allow it, the total ankle prosthesis remains an option. The main disadvantage is its lifespan (10 to 15 years). In case of failure or end of life of the implant, it will be necessary to perform an ankle arthrodesis with or without bone grafts.

The assessment before total ankle prosthesis

Before a total ankle prosthesis is inserted, it is essential to carry out a complete assessment, based on a clinical examination and additional tests.

The clinical examination allows the assessment of the articular amplitudes of the ankle and of the other joints. The surgeon will look for surgical contraindications such as severe deformities or comorbidities.

The imaging workup is based on additional examinations including:

Other examinations such as MRI can be performed if the surgeon uses a prosthesis with a personalized cutting guide. After acquiring the bone shapes of the tibia and the talus, a cutting guide is made to measure in the laboratory. This is sterilized and used by the surgeon in the operating room. It allows precise cuts by adapting perfectly to the patient's anatomy. These custom-made cutting guides are a real revolution in prosthetic ankle surgery. They allow the surgeon to be precise, they improve the precision of the prosthesis placement: the life span of the prosthesis is increased.

Surgery and postoperative care

The major interest of this technique is to preserve the mobility of the ankle. It is a demanding technique reserved for patients who meet strict criteria in order to obtain an optimal result.

Hospitalization:
The procedure is usually performed in hospital for 3 to 7 days.

Anesthesia:
You will have to undergo the obligatory pre-anaesthetic consultation with the anaesthetist. During this consultation, the anaesthetist will explain the possible modes of anaesthesia according to your associated pathologies and the planned surgical procedure. If necessary, he will adapt your treatment before and after the operation and may prescribe anticoagulants, painkillers, anti-inflammatory drugs or others. Several types of anaesthesia are possible: you can benefit from a local or regional anaesthesia meaning that only your leg will be desensitised: this is the most common. General anaesthesia is also a solution if you prefer to be asleep.

Intervention:
Before the operation for a total ankle prosthesis: you will be placed on a bed and taken to the pre-anaesthesia room. The local anaesthetic will be given before you enter the operating room. Installation in the operating room: you will be installed in dorsal decubitus, i.e. on your back

The tourniquet: Throughout the procedure, a tourniquet is usually placed on the thigh to prevent bleeding.

The incision: the incision measures 10 to 15 cm on the anterior surface of the ankle.

It is important to note that the surgeon may be faced with an unforeseen or unusual situation requiring different procedures than those initially planned. In this case, the surgeon will explain to you the difficulties encountered and the procedures performed as soon as you wake up or return to your room.

What are the after-effects of the operation?

WALKING
There is no immobility after a total ankle prosthesis operation, walking is allowed with the boot from the day after the operation. The boot must be worn day and night for 15 days. Walking is facilitated by crutches or a walker for 30 to 60 days.

DRESSING AND HOME CARE
Dressing care is necessary for 15 to 21 days. Remember to contact a nurse to organize the repair of the dressing in the 2 days following the operation.

SWELLING
Swelling is not a complication and is common after such an operation. To limit the swelling of the foot, it is recommended to limit your movements for the first few days, apply ice and keep your leg elevated when you are at rest. Do not stand still and do not walk.

MEDICAL TREATMENTS
Depending on your history, your existing medical condition and your mobility, the anaesthetist will prescribe an anticoagulant treatment by injection (subcutaneous) or by general way (per-os). This treatment prevents the appearance of phlebitis, i.e. the formation of a clot in the veins. It is strongly advised to take the prescribed painkillers systematically during the 5 days following the surgery.

KINESITHERAPY
Physiotherapy is essential, it will be carried out by a physiotherapist or in a rehabilitation centre.

DRIVING AND ABSENCE FROM WORK
Driving is forbidden for 3 to 4 weeks (unless you have had surgery on your left foot and you have an automatic car). The average time off work is 45 to 90 days depending on your professional activity.

SPORTS ACTIVITIES
Sports activities are possible after ankle arthroplasty. After the 2nd month after surgery, cycling and swimming are possible. In the long term, less strenuous sports activities such as hiking, skiing or golf are permitted. Obviously, pivot-contact sports are prohibited (running, soccer, etc.).

POST-OPERATIVE FOLLOW-UP
Several post-operative appointments are necessary: 21st day, 2 months, 6 months and 1 year after the operation. After 1 year, an annual follow-up with a control X-ray is performed.

Specific complications
In addition to the classic surgical complications, the main complications of total ankle replacement surgery are infection (3%) and loosening (5%). Other complications include malleolar fractures, skin problems (necrosis) or residual pain and stiffness. Most complications can be treated without the need for revision surgery. However, in other, rarer cases, it is sometimes necessary to remove the prosthesis and perform an arthrodesis with bone grafting.

IN CASE OF QUESTIONS
If you have any questions or problems, you can contact his secretary.

In conclusion
The installation of a total ankle prosthesis obeys strict criteria for the selection of patients. It is an operation that requires several months of re-education, it will take 6 months to obtain a satisfactory result and 1 year for a definitive result. In the absence of complications, it brings a significant functional improvement both in terms of pain and walking. Walking without crutches and without pain is generally possible. Depending on your physical condition, gentle sports activities can be resumed after several months and in agreement with your surgeon. Currently, with the new prostheses and fitting techniques, the life span of an ankle prosthesis is around 80-90% at 10 years. In case of early problem or at the end of the life of a PTC, it will be necessary to perform a surgical revision to change the prosthesis or to perform a definitive blocking of the ankle (arthrodesis). In young, active patients, we do not have enough experience to establish reliable statistics on lifespan. On the other hand, total ankle prosthesis seems to be an interesting way of gaining a few years while waiting for an arthrodesis to be performed.

Focus on subtalar osteoarthritis surgery near 06

Surgery for subtalar osteoarthritis should be considered when you experience pain and swelling despite medical treatment.

The signs of subtalar osteoarthritis are pain in the back of the foot (especially when walking on rough ground) and stiffness. The pain is often felt on the outer side of the ankle, just in front of the lateral malleolus. Subtalar osteoarthritis most often occurs as a result of calcaneal fractures, talus fractures or chronic inflammatory diseases such as rheumatoid arthritis

subtalar osteoarthritis gif

Why does this happen?

The subtalar joint allows the foot to adapt to unstable terrainIt performs this role thanks to 2 other joints: the calcaneo-cuboidjoint and thetalo-navicularjoint (torsion torque). Trauma is the most frequent cause subtalar osteoarthritis. Examples are calcaneal fractures or talus fractures, old or new. Inflammatory diseases such as rheumatoid arthritis can also destroy the subtalar joint (arthritis)

In the case of thetalonavicularjoint trauma and fracture sequelae are the most common causes of this type of damage. Fractures of the talus or navicular can cause talonavicular osteoarthritis. Inflammatory diseases such as rheumatoid arthritis or certain deformities of the foot such as flat foot are also common. There are rarer causes: infections, osteochondritis, necrosis and synostosis also advanced flatfoot, which is frequently associated with talonavicular osteoarthritis.

When no cause is found, it is called primary osteoarthritis.

The symptoms

The main symptom is "mechanical" pain, i.e. it appears during activities such as walking or sports. They are more important during activities on uneven ground. There may also be swelling of the ankle or stiffness (reduced mobility).

How is it evolving?

It is not possible to cure osteoarthritis, it slowly evolves towards aggravation. The pain and swelling increase and the functional impact progresses. At an advanced stage, a limp may appear which requires the use of a cane to walk.

How is subtalar osteoarthritis treated?

Treatment is always medical in the first instance: infiltration, pain medication, modification of footwear and activity, insoles or physiotherapy. In case of failure, arthrodesis (surgical fusion) of the subtalar joint remains the reference surgical treatment.

Surgery for subtalar and talonavicular arthrosis

Surgery for talonavicular osteoarthritis must be performed by a foot surgeon. It allows a definitive blocking of the joint and eliminates the pain.

Subtalar osteoarthritis is common, whereas damage to the talonavicular joint is rare. This joint allows the foot to adapt to unstable terrain. It fulfils this role thanks to two other joints: thecalcaneo-cuboidjointand the subtalar joint(torque)

Hospitalization:

The procedure is usually performed in a hospital and requires a 2 to 3 day hospital stay.

Anesthesia:

You will have to undergo the obligatory pre-anaesthetic consultation with the anaesthetist. During this consultation, the anaesthetist will explain the possible modes of anaesthesia according to your associated pathologies and the planned surgical procedure. If necessary, he will adapt your treatment before and after the operation and may prescribe anticoagulants, painkillers, anti-inflammatory drugs or others. Several types of anaesthesia are possible: you can benefit from a local or regional anaesthesia meaning that only your leg will be desensitised: this is the most common. General anaesthesia is also a solution if you prefer to be asleep.

Intervention:

Local anaesthesia will be performed before entering the operating room.

It is important to note that the surgeon may be faced with an unforeseen or unusual situation requiring different procedures than those initially planned. In this case, the surgeon will explain to you the difficulties encountered and the procedures performed as soon as you wake up or return to your room.

What are the after-effects of the operation?

WALKING
Walking is forbidden for 45 days and the ankle is placed in a boot at the end of the operation. The boot is to be worn day and night. Walking is facilitated by crutches, a walker or a wheelchair.

DRESSING AND HOME CARE
Dressing care is necessary for 15 to 21 days. Remember to contact a nurse to organize the repair of the dressing in the 2 days following the operation.

SWELLING
Swelling is not a complication and is common after such an operation. To limit the swelling of the foot, it is recommended to limit your movements for the first few days, apply ice and keep your leg elevated when you are at rest. Do not stand still and do not walk.

MEDICAL TREATMENTS
Depending on your history, your existing medical condition and your mobillity, the anaesthetist will prescribe an anticoagulant treatment by injection (subcutaneous) or by general way (per-os). This treatment prevents the appearance of phlebitis, i.e. the formation of a clot in the veins. It is strongly advised to take the prescribed painkillers systematically during the 5 days following the surgery.

KINESITHERAPY
Physiotherapy is essential, it will be carried out by a physiotherapist or in a rehabilitation centre after the first postoperative consultation.

DRIVING AND WORK STOPPAGE
Driving is forbidden for 8 weeks (unless you have had surgery on your left foot and you have an automatic car). The average time off work is 4 to 6 months depending on your professional activity.

SPORTS ACTIVITIES
Sports activities are possible after a subtalar arthrodesis.After the 2nd month after surgery, cycling and swimming are possible. In the long term, less strenuous sports activities are permitted, such as hiking, skiing or golf. Obviously, pivot-contact sports are prohibited (running, soccer, etc.).

POST-OPERATIVE FOLLOW-UP
Several post-operative appointments are necessary during the 1st year.

Specific complications
In addition to the classic surgical complications, the main complications of arthrodesis surgery are infection and non-union (pseudarthrodesis). The majority of complications can be treated without the need for repeat surgery. On the other hand, in other, rarer cases, it is sometimes necessary to operate again, particularly in the absence of bone consolidation.

In conclusion
Subtalar arthrodesis requires several months of re-education; it will take 4 to 6 months to obtain a satisfactory result and 1 year for a definitive result. In the absence of complications, it brings a significant functional improvement in terms of both pain and walking. Walking without crutches and without pain is generally possible. Depending on your physical condition, gentle sports activities can be resumed after several months and in agreement with your surgeon.

Complications of osteoarthritis surgery

The following list of complications is not exhaustive, but the most common complications of ankle osteoarthritis surgery are mentioned.

Any surgery exposes to complications both common and specific to the type of operation performed. This risk varies from one individual to another depending on age, existing medical conditions (hypertension, diabetes, poor skin condition, etc.) and lifestyle (smoking, alcohol, sports activities).

Some complications can be prevented by simple measures such as:

  • compliance with postoperative instructions
  • stopping smoking

Common Complications

  • haematoma is an uncommon complication, favoured by certain medical treatments (anticoagulants). Some risky drugs can be stopped and taken over by the anaesthetist. The haematoma rarely requires a surgical revision, it is most often resorbed with ice and rest.
  • scarring problems are frequent. Their occurrence is increased by tobacco and poor skin condition.
  • The swelling is not a complication but a reaction of the body to the aggression represented by the surgery. In order to reduce its importance, it is useful to carry out self-education by moving the toes, to limit movement for 15 days and to raise the foot as much as possible when you are lying down.
  • Thrombophlebitis is the formation of a clot in a vein, most often in the leg or foot. It is prevented by administering an anticoagulant treatment for 10 days.
  • Algodystrophy or "complex regional pain syndrome" is an exaggerated reaction of the body to the aggression represented by surgery. The symptoms are: redness, stiffness, fluid retention and pain. The evolution is always towards recovery without after-effects but the evolution is long (up to 18 months). Some simple measures minimize this risk:- do not let the pain settle, systematically take the painkillers prescribed by your surgeon during the 48 hours after surgery- take the preoperative treatment (vitamin C)- in case of previous algosytrophy, a medication will be prescribed before the operation (lyrica)

Infection may occur despite precautions (preoperative shower, aseptic surgical preparation). It must be evoked in case of fever, scar disunion, purulent discharge or important redness. It requires a surgical opinion.

Specific complications

  • Pseudarthrodesis is the most frequent complication of arthrodesis and osteotomy. It is an absence of bone fusion at the 6th postoperative month. This complication occurs in 10% of cases. It requires a surgical revision in certain cases.
  • Bone necrosis is the death of the bone due to damage to its vascularity.
  • Stiffness: Ossification can occur around the prosthesis, sometimes leading to secondary stiffening.
  • Loosening: the prosthesis is not well fixed on the bone. It is necessary to carry out a new operation.
  • Secondary displacement or disassembly of equipment is the displacement of the assembly or equipment during the bone healing period. Unloading with the boot and following the instructions will reduce this risk. It most often occurs as a result of trauma or a sudden landing on the operated foot.
  • Osteoarthritis is the wear and tear of cartilage. In the case of arthrodesis, the blockage of a joint overloads the neighbouring joints, which may deteriorate.

FAQ

What is osteoarthritis of the ankle or foot?

Osteoarthritis is the wear and tear of the cartilage of a joint. It is often called osteoarthritis. In a joint, the bones slide together thanks to a coating called "cartilage": it is white and smooth like a hard-boiled egg. When the cartilage breaks down, it is called osteoarthritis.

Which specialist to treat osteoarthritis of the ankle?

An orthopaedic surgeon specialising in osteoarthritis of the ankle is the most appropriate person to manage this treatment. Don't forget to consult your GP for any initial consultation so that he can direct you to the best practitioner.

How to treat osteoarthritis without surgery?

It is not possible to cure osteoarthritis but the pain can be relieved. For Osteoarthritis of the ankle and foot the treatment is always medical in the first instance. Before considering an operation for osteoarthritis of the foot, we start with a non-operative treatment. The aim is to reduce the pain, but this does not prevent the osteoarthritis from progressing.

When to operate on osteoarthritis of the ankle or foot?

When medical treatment is no longer effective and functional discomfort is significant, surgery for osteoarthritis of the ankle or other joints may be proposed. The surgical principle depends on the level of functional demand (level of activity), the age of the patient, and the affected joint and its degree of damage. objective of the surgical treatment is to make the pain disappear, to have a foot or ankle fit and centered compatible with your functional desires.

How to operate on osteoarthritis of the foot and ankle?

The surgical procedure also varies according to the joint affected and the stage of the osteoarthritis. We can generally describe different types of surgical treatment for osteoarthritis: debridement arthroscopy, arthrodesis consists of removing the joint, joint prosthesis (total ankle prosthesis or TAP) or arthroplasty concerns only the ankle and osteotomies consist of making bone fractures in order to modify the axes.

How long does surgery for osteoarthritis of the ankle and foot last?

The duration of the surgical procedure depends on the operation performed; it generally lasts from 30 minutes to 3 hours.

What is the anaesthesia for osteoarthritis surgery?

Several types of anaesthesia are possible: you can benefit from a local or regional anaesthesia meaning that only your leg will be desensitised: this is the most frequent. General anaesthesia is also a solution if you prefer to be asleep.

How much pain do I feel during surgery for osteoarthritis of the ankles and feet?

The pain also varies with the surgical procedure performed. Pain management is ensured by a prescription of appropriate medication, rest, elevation of the leg and regular application of ice. In very painful surgeries, a catheter can be put in place for a few days to obtain complete analgesia.

What is the period of immobility after surgery for osteoarthritis of the foot or ankle?

No immobility is necessary in the case of simple debridement. In the case of an ankle prosthesis, support is allowed immediately with a boot. In arthrodesis, support is forbidden for 45 days with a boot.

Am I allowed to drive after surgery?

Driving can be resumed between 15 days and 2 months depending on the surgery.

Can we operate on both feet at the same time?

No, it is not possible to operate on both feet at the same time.

What is the cost of an operation for osteoarthritis of the foot or ankle?

The operation for osteoarthritis of the foot and its prices vary according to the nature of the procedure to be performed. Social security covers the cost of the operation. The reimbursement of additional fees depends on your insurance contract. The remaining cost after reimbursement by your insurance company can reach 2000€

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