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Underground Architecture Of Ankle

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor

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For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.
The Department of Orthopedic Surgery of the Centrokinetic Clinic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.
Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

Subtalar arthroscopic arthrodesis is indicated in advanced talocalcaneal arthrosis, which occurs most often after a complex fracture of the calcaneus, regardless of whether it is treated orthopedically or surgically. The ideal intervention has a 100% chance of success on the first possible attempt (90-95% in the case of subtalar arthroscopic fusion) and allows the patient to recover as quickly as possible. It should be almost painless after the intervention.

This description indicates the main advantages of subtalar arthrodesis, which leads to a faster recovery time due to very little postoperative pain.

The operation is performed using two small incisions, one in the lateral area of the ankle near the sinus tarsi and one in the posterior area of the ankle, as well as two other small incisions to place the two screws needed for fixing (usually the back of the ankle).

Surgical technique

The patient receives a spinal (spinal) anesthesia and is placed on one side of the operating table. Subsequently, a hemostatic band is mounted on the affected limb in order not to bleed during the operation. 

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The intervention involves making two incisions of about 4mm in the lateral and posterior area of the ankle and the introduction of an optical camera 2.8 or 4mm thick to inspect the affected joint (subtalar). All the remaining articular cartilage is removed and the articular surfaces are regularized so that the contact between the 2 bones (calcaneus and talus) is as high as possible. Subsequently, 2 more incisions of about 5 mm are made in the posterior area of the ankle, near the heel, and under radiological control, the affected joint is fixed with 2-3 titanium screws, 5-7 mm thick, compacting (approaching) the 2 bone surfaces.

The use of the arthroscopic technique of subtalar arthrodesis also means that most patients avoid the complications given by a classic intervention: incision of about 10-12 cm, pain, risks of infection, to damage local anatomical formations.

Low pain and high mobility mean that most patients require a single postoperative day in the hospital.

The most important difference is the chance of a successful arthrodesis. With the arthroscopic technique, there is a success between 90-97%. At best, with the option open, we can expect a primary fusion rate of 80-90% (this means the chance that the fusion will take place after the first operation).

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Postoperatively

After the intervention, the patient remains hospitalized for 1-2 days. He will receive pain medication and antibiotics during his hospitalization. The operated limb is partially immobilized in a very light fiber splint, for 8 weeks. Free walking is not allowed in the first 6 weeks postoperatively, you must use crutches.

At home

Although recovery from an arthroscopic ankle arthrodesis is much faster than a classic operation, it will still take a few months for you to fully recover after the intervention. You should expect pain and discomfort for at least a week postoperatively. Ice will reduce pain and inflammation.

You must be careful not to lean on the operated ankle in the first weeks because the pain and discomfort can worsen. You can take a bath, but without wetting the bandage and incisions. The threads are suppressed at 14 days postoperatively. 

After 6 weeks, a radiological examination is made and if the results are good, the patient can begin to step easily on the operated limb. However, the patient will give up crutches after a minimum of 10 weeks, but in some cases, the prognosis is 12 weeks.

It is very important to follow the recovery program strictly and seriously for the surgery to be a success. Our medical team works on average with the patient after this intervention, 18-24 weeks until complete recovery of the operated area.

Following any surgery, medical recovery plays an essential role in the social, professional, and family reintegration of the patient. Because we pursue the optimal outcome for each patient entering the clinic, recovery medicine from Centrokinetic is based on a team of experienced physicians and physical therapists and standardized medical protocols.