Hello we're gonna talk about ankle arthritis and indication for ankle fusion.
Ankle fusion is the gold standard treatment for people with
post-traumatic arthritis, rheumatoid arthritis or deformity of the ankle
not responsive conservative care.
I mean that's the end of the line treatment for people with
severe arthritic pain at the ankle.
Now how does arthritis in the ankle happen?
Well you could have rheumatoid arthritis
which is an inflammatory joint disease
where your body attacks its own cartilage,
that's number one.
You could also have post-traumatic arthritis,
let's say you fell down from a tree
or some kind of industrial accident
and you injured the ankle joint
or your heel bone etc and you end up
getting injury to the cartilage and
your ankle wears down over time.
You could also have a
deformity in the ankle,
let's say you have undiagnosed let's say
ankle ligament laxity such as
you're very athletic, you play a lot of sports
and you injured your ankle ten years ago
and you have an unstable ankle,
the joint is not congruent or not exact and
you start wearing away your ankle joint
sort of like an uneven break on an
uneven road or you're gonna wear in
an uneven pattern and things
are gonna wear out a lot faster,
anything even one millimeter shift in
difference in the ankle joint itself
with ligament laxity can cause
advanced arthritis in the ankle joint.
Now this is the foot bone,
this is the bone called the talus,
this is the bone that articulates or
connects to the ankle bone.
Down here is the subtalar joint
right about here that is the joint
underneath the talus bone.
I'm going to show you my patient x-rays
and we'll talk about a little bit more,
you'll see it more on the x-rays,
I just want to show you that this is a nice
supposed to be a nice area
of cartilage on top of here,
nice area of cartilage down here.
Now some people have pain, they think
it's coming down from the ankle.
I get that
common misdiagnosis,
a lot of times the patient
or even their primary care doctor will say,
you just have some ankle arthritis,
just come and take an x-ray and this joint
is shot right here.
It's not the ankle joint.
That's good news because that
is not the ankle joint, that is what we call
the subtalar S-U-B-T-A-L-A-R, that joint is
actually in the foot and that joint
can be easily fused.
This topic -- this video -- is about
arthroscopic fusion which we're able to do
this via a small camera by four millimeter
size camera as well as another equipment
called a shaver or an osteotome which is a
chisel and hammer and about
four millimeters in size also.
So we're not doing a big incision
not causing a lot of collateral damage.
There's a lot of benefits
to doing it this way.
Number one there's a minimal bleeding
there's also less chance of complication of
a wound infection, wound dehiscence and
patients heal a lot faster because of l
ess collateral damage that we are creating
as a surgeon when we're going in
and doing these fusions.
There's also fixation methods now that
are done percutaneously or meaning that
it does not require us to open
the patient up in order to put this in.
We could do it through the x-rays --
live x-rays that we can use in the
operating room called fluoroscopy.
So I'll show you the case,
we're gonna talk to the patient,
you'll get to see what the patient
looks like at about two weeks post-op and
about four weeks post-op
along with his x-rays,
we'll discuss a little bit more,
thank you.
This is an actual pre-surgical x-ray
of an actual patient of mine, you can see
the joint space narrowing
where the arrows are pointed,
the ankle joint is the one on top and then
the subtalar joint is the one
in the bottom arrow.
Again this is a side view, this what it
typically looks like on an x-ray.
This guy has more ankle joint arthritis
than subtalar joint arthritis but they're both very arthritic.
What you don't know is a CT scan
was ordered and it confirmed such.
We're going to look at the final view,
this is the rod, you see the rod in there and
that's the screws, that is what's holding it
in place as you can see at four weeks out
the fusion has already started to
take place, the mending of the bones has
started to happen.
This is the patient status post ankle and
subtalar joint arthrodesis via a
scope approach --
arthroscopic minimal incision approach.
This is the outside, this is swelling at
2 weeks, it's an angulation at 2 weeks,
slightly plantar flex for purpose of the
ankle fusion right there,
it's at 90 right now right here with the
forefoot going back up
we're gonna go around this side
this is the marking an incision and the
insertion point of the iron rod into
the medullary rod and this again is the
medial side so this approach is using the
two small incisions on each side
right here for the ankle and then
this incision for the access to
what we call the subtalar joint,
the joint underneath the ankle.
So this whole complex is fused into
one solid unit from here
down to here and the reason why
we do that is for severe end stage arthritis
not responsive to any kind of
conservative care.
So as you can see the swelling is
very minimal and very happy
with the swelling.
We'll go ahead and -- this is two weeks
right now so not bad at all
as far as swelling is concerned.
78 year old gentleman with severe
ankle arthritis and subtalar joint arthritis
done via the arthroscopic approach.
This is the lateral portal of the
ankle arthroscopy, this is the
subtalar joint portal.
We're talking about just three weeks
out of surgery right now,
this is where the IM rod was inserted
this is still the marking from the
Stryker rod, incision is all healed up
this is the medial incision right now
and we're gonna go back this is one
of the insertions for the
calcaneal screw of the rod.
This is the leg incision, so a lot this stuff
was done arthroscopically
and with fluoroscope,
patient is rehabbing well at the
rehab facility and this is the position of
the subtalar with ankle scope.
This 90 degrees is perfect,
exactly how we want it, so he's gonna
be non-weight-bearing for about 12 weeks
as usual protocol, put in a cast,
immobilization to allow for proper healing,
increase in healing rate secondary to
not having to do an open incision
and as you can see
the incision have all healed.
How much pain have you had
throughout this whole thing?
Not too much, a lot?
"Well originally, quite a bit."
Okay, for how long?
"Recently, in the last week or so, not much.
In fact, I've had to take pain medicine
because of arthritis of the
shoulders and the knee.
I can't straighten this anymore because of
all the effort I was putting on
to raise myself."
So you have more pain in the knee
and your shoulder than your ankle
that we did surgery on three weeks ago.
So good, good, good.
I think you're healing right on target
my man, we're gonna get you another cast
and go on from there sir.
Okay.
This is the pre-op film again
from the front view, now that you've seen
the patient this is the x-ray before.
Before, again, you see the arthritis,
the joint space narrowing, there's hardly
any joint space left the ankle joint and
moderate joint narrowing there.
This is the rod in place and
the patient had a perfect alignment
and fusion started.