Triple Arthrodesis Surgery Miami

We have already talked about this throughout the article, so let’s deal with the topic here point by point and succinctly. This will help to clarify and systematize the advice that the patient must follow to the letter during the 12 weeks or three months that the rehabilitation lasts, because otherwise there is a risk that the triple arthrodesis surgery will not be successful. These tips are generic, not casuistic. It is best to consult with the doctor who performed the triple arthrodesis surgery, what are the things you can and cannot do after the operation.

• During the first 6 weeks (half the rehabilitation time) you must rest completely. The person cannot attend work or do housework.
• During the first six weeks you cannot put weight on your foot, nor can you place the weight of the body on the operated foot.
• You should not go up or down stairs, so you have to put the resting place, the sleeping bed and an alternative bathroom in the same place.
• During the second six weeks (the other half of the rehabilitation time) rest does not have to be absolute, but the type of special footwear supplied by the surgeon must be strictly used.
• In this second half of the rehabilitation, certain moderate weight can be placed on the foot, but always using the special footwear supplied by the surgeon.
• During this second half of the rehabilitation (and actually until the doctor indicates), the patient must continue without doing sports or activities of intense physical effort.
• It is highly recommended that at this stage the patient receive physiotherapy. It has been shown that patients who receive physiotherapy recover better (not faster but with better quality in terms of achieving all the objectives of the operation).

This response must be divided into 2 or 3 stages, depending on the patient. Total rehabilitation time is usually 12 weeks or 3 months. Rehabilitation can be extended to 4 months, but it would already be without immobilization of the foot, without absolute rest and with physiotherapy.

• First six weeks: During the first 6 weeks, it is strictly forbidden to place any type of weight on the foot,  it is even forbidden to put the weight of the body on the operated joint.
• Second six weeks: During the second half of the recovery, that is, during the six weeks that constitute the second half of the total rehabilitation time of 12 weeks, the patient can place weight on the foot at will, with caution, but always using special footwear which is supplied by the clinic.
• Extra time: The vast majority of patients have recovered after 12 weeks. The extra rehabilitation time is only for a few cases of patients. It may be around 1 more month, and during this time the patient will be able to place weight on the foot to the extent determined by the surgeon or physiotherapist, either in daily life or in physiotherapy.

It is not absolutely essential in triple arthrodesis surgery to place devices to fix the bones. As discussed above, in the operation the calcaneus, talus, navicular, and cuboid bones are manually corrected toward their correct position. And after this, very often surgeons choose, for greater security, to fix said bones in that new position by means of screws, nails or staples.

In this way it is much safer for the foot to remain in its natural alignment and what is called “pseudoarthrosis” is avoided, which is nothing more than a false fusing of the bones. Later, when fusing has actually been achieved (which is more like fusion in the case of triple arthrodesis surgery), the surgeon will remove the fixators if they have been placed.

However, it must be reiterated that nails, screws, staples, or other types of metallic implants are not always used. In the absence of the use of metal fixators, in some cases bone grafting is used (using bones from other parts of the patient’s own body is almost always preferred, but bones from donors or from a bone bank can also be used). In other cases, synthetic bones (made based on granules and hydroxyapatite or tricalcium phosphate) are also used, which emulate natural bones very well.

Triple arthrodesis surgery is performed with the patient under anesthesia, and this ensures that the procedure itself does not hurt at all. After the surgery, when the effects of the anesthesia wear off, the patient may feel some postoperative pain. Any surgical operation implies a certain degree of invasion into the body, however little it may be. The specific degree of pain will depend on the pain threshold of each patient. But there are patients who consider that it is not a surgery with painful effects. In any case, the surgeon will prescribe analgesics that eliminate any trace of pain, and if the patient fully complies with postoperative rest, the pain will be minimal or none.

We already saw towards the beginning of this article that one of the main reasons for triple arthrodesis surgery is to treat and alleviate pain that is considered intractable by non-surgical means (that is: therapies, physiotherapy, anatomical support devices, analgesics, etc. ) Taking into account the considerable degree of pain that the patient experienced before surgery, it is rare that a patient who felt such pain does not feel less pain after having the operation.

Surgery may not completely relieve pain in a percentage of cases, but it will not make it worse in the vast majority of patients either. Even in cases in which patients feel that the surgery hurts a little when the anesthesia wears off, or that rehabilitation is uncomfortable, the vast majority of them answer yes to the famous question of whether they would undergo surgery again if necessary, since it is worth an uncomfortable period to alleviate great pain.

Triple arthrodesis surgery and double arthrodesis surgery are the same surgery. It is actually a confusion of terms. It so happens that, among surgeons in Europe, this procedure is known as double arthrodesis surgery , because they consider the calcaneocuboid and talonavicular joints to be a single joint (following the concepts of the 18th century French surgeon François Chopart).

On the other hand, Anglo-Saxon surgeons are the ones who call the procedure that we have analyzed here triple arthrodesis surgery , because they consider that each of the joints involved, although from the functional point of view they work as a whole, from the anatomical point of view they are three isolated joints.

Despite what we have just said (which is the most general criterion), there are specialists who consider and support that triple arthrodesis surgery and double arthrodesis surgery are two different procedures.

Immediately after surgery, the patient will be placed in a low cast, which will immobilize the foot and ankle and prevent them from wearing any type of footwear. This should last about a month and a half, that is, six weeks. Following this time interval, the patient will likely be required to wear a special type of shoe supplied by the surgeon, possibly for an additional six weeks, or for as long as the surgeon directs.

Regarding the use of shoes and other types of footwear once the patient is discharged after 3 or 4 months, this will depend on the case. The prospects are mainly good. As we saw in the AOFAS scoring scale table cited above, up to 61% of patients who have undergone triple arthrodesis surgery manage to wear shoes of all types after the operation.

Only 39% of the cases stated that they needed to wear more comfortable shoes after the operation, which does not necessarily show that they worsened with the surgery. So that no patient (and in this the exceptions are very few) declares not being able to wear shoes at all after surgery.

The best thing, perhaps not to speed up, but at least to avoid delaying recovery, is to fully comply with the rest times indicated by the doctor, not put weight on your foot until possible, and use the special footwear that the doctor provides . In principle, it will have to rest for about three months in total. But it is better that it is the doctor who dictates what time it should be.

A study that we already mentioned above, carried out in 2003 with 40 patients who had received triple arthrodesis surgery, concluded that patients recover optimally in a time of no more and no less than 12 weeks (approximately the 3 months that we already mentioned). Less time than that does not guarantee a correct fusion of the joints. The cited study showed that, of the patients who had a rehabilitation of less than 12 weeks, none obtained good results, but only fair to poor results.

Something that can improve the quality of recovery (although not speed it up) is receiving rehabilitation treatment and physiotherapy. Patients who receive rehabilitation during recovery do not recover sooner, but they do recover better. As is known, physiotherapy is considered an ideal complement to practically all orthopedic surgical procedures, since it promotes the restoration of muscular and joint functions, and stimulates a good circulatory and emotional state of the patients.

As we have reiterated throughout the article, in a certain percentage of cases, after triple arthrodesis surgery, arthritic sequelae can be generated. Pseudarthrosis can also be generated, which, despite its name, is not an arthritic-type disorder but a false fusion of the bones. In a percentage of cases of pseudarthrosis, the disorder may be completely asymptomatic, while in another percentage there may be pain and affect the normal functioning of the foot.

If the question is whether the patient can play sports shortly after triple arthrodesis surgery, the answer is that he absolutely cannot play sports until later. During the first 6 week interval after surgery, the patient will not even be able to put weight on the foot. And then, for a second six-week interval, you will be able to place weight on the foot only when wearing the special type of shoes your surgeon will provide you.

The total time in which the patient must maintain this care will depend on his own condition, his state of health, his postoperative evolution, and ultimately will depend on the surgeon’s criteria. In this type of operations there are no absolute times. The best thing is that the surgeon is the one who indicates when the person can do sports.

The answer is yes. Insurance usually covers triple arthrodesis surgery. Doubts regarding insurance arise from the fact that it does not usually cover cosmetic surgeries, or at least does not cover them in full. But in the case of triple arthrodesis surgery, it is a procedure that is entirely aimed at resolving a physical condition of the foot that generates severe pain and greatly hinders the person’s normal life.