Underground Architecture Of Ankle

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. 

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).

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