Triple Arthrodesis is a surgical procedure that involves the fusion of the subtalar, talonavicular and calcaneocuboid joints. This is an effective treatment for severe hindfoot arthritis, instability or deformity.
The human foot consists of 26 bones that form 33 distinct joints. The three joints at the back of the foot, called the subtalar, talonavicular, and calcaneocuboid, allow side to side movement of the foot.
Surgical Procedure
Triple arthrodesis involves surgical fusion of the three joints below the ankle that allow side-to-side foot movement and flexibility. These are the subtalar, talonavicular, and calcaneocuboid joints. The surgery eliminates motion of these joints and helps alleviate pain and allows for a more stable foot structure.
It is often used when nonsurgical treatment has failed to alleviate severe pain or a deformity of the foot. Nonsurgical treatment includes steroid injections, orthotic devices, physiotherapy, activity modification, and avoiding activities that cause pain or instability.
In addition, your physician may recommend surgery in patients with certain risk factors including uncontrolled comorbidities, progression of Charcot arthropathy with the potential for ulceration or a non-propulsive gait, and lack of trial of conservative therapy.
During the procedure, your foot and ankle surgeon makes an incision on each side of the foot. Then, your doctor removes the arthritic joint surfaces and fixes them together with plates or screws. A thigh tourniquet is used to control bleeding during the procedure, and X-rays are used in surgery to confirm that the bones are in the correct position.
During the procedure, your doctor may place a bone graft from another area of the body (usually from the pelvic bone near the hip) to help the bones fuse together. This can result in a patch of numbness on the side or top of the foot.
Recovery
Triple arthrodesis is a surgical procedure that involves the fusion of three joints at the back of the foot. These joints, called the subtalar, talonavicular, and calcaneocuboid joints allow side-to-side foot movement as well as up and down movement. When these joints become painful and deformed due to arthritis, an experienced Orthopaedic Surgeon in Adelaide may recommend this treatment option. The procedure reduces pain, improves alignment and creates a more stable foot structure for walking and other activities once healed.
The surgery is performed under local or general anesthesia and takes around two to 2.5 hours for completion. Your surgeon makes two incisions on the foot to gain access to the desired joints and performs work on them, including removing damaged cartilage, roughening boney surfaces, and filling defects. Then, hardware is placed to keep the bones in place and promote healthy fusion.
Following the surgery, you will be placed in a splint to restrict movements and keep the foot elevated to reduce swelling. You will also be prescribed medications to ease post-operative pain. Your recovery from Triple Arthrodesis will take a few weeks to several months.
Generally, Triple Arthrodesis is used when nonsurgical treatments such as NSAIDS, physical therapy, strapping and steroid injections have failed to relieve the pain or correct deformities of the foot and ankle. The surgery is also used to treat Charcot arthropathy after coalescence and for patients who have a high risk of ulceration or an unpropulsive gait due to their condition.
Post-Operative Care
Triple arthrodesis is a surgical procedure that fuses the three joints in the back of the foot that allow side-to-side and up/down movement – the subtalar, talonavicular and calcaneocuboid joints. It is used to relieve pain and correct deformities when conservative treatment approaches have failed or are not feasible.
The surgery is performed under local anesthetic and usually does not require a blood transfusion. A tourniquet is applied around the thigh to prevent bleeding during surgery and intraoperative fluoroscopy may be used to confirm that the bones are correctly aligned and are being held in place with the right fixation. Screws are often required to help achieve fusion and these may be placed using various types of hardware.
Patients are normally placed into a splint or boot for the remainder of their recovery and may need crutches or a knee scooter to assist them with mobility while they heal. During this time, weight should be kept off the foot as much as possible to promote healing and reduce the risk of complications.
Once the fusion has healed, patients typically experience significant reduction or elimination of pain and improved stability in the foot and gait. It is important to discuss any concerns or limitations that may be present with your surgeon. In many cases, patients are able to resume work and activities within a reasonable period of time, although the use of high impact sports may be limited.
Follow-Up
The Triple Arthrodesis surgery is a powerful tool for treating severe pain and stiffness in the back portion of the foot (hindfoot) that fails to respond to non-surgical care. The operation fuses together three joints in the back of the foot that are responsible for side to side and up and down movement of the foot. The fusion reduces the overall range of motion of the foot but allows patients to continue walking with pain free ambulation.
In a retrospective clinical and radiological study, Saltzman and colleagues evaluated the outcomes of isolated talonavicular arthrodesis in patients who had failed to respond to conservative treatment options. Patients were followed for an average of 25 and 44 years. At that time the naviculocuneiform joint showed no degeneration, tarsometatarsal joint degeneration was observed in 1 percent of patients and the talonavicular joint had arthrosis in 2 percent of patients. The arthrosis in the ankle joint was associated with reduced AOFAS scores but did not affect the naviculocuneiform or tarsometatarsal joint function.
Out of 36 isolated talonavicular arthrodesis procedures performed by the senior author, two patients would not have had this procedure done and one patient was not satisfied with the result (patient satisfaction failure rate 8%). While this is a low patient satisfaction failure rate for the procedure, the authors conclude that it is likely time for triple fusion to be retired due to the number of complications it is prone to.