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Medical Forum / Diseases and Disorders / Arthritis / October 2007Ankle Triple Fusion?
Hi, Has anyone done a triple fusion before? Do you know whether there are any side effect?. Do you know whether this will cause pain or damage, due to deterioration of the body as it grows older.. over the age of 50? or anything you have to beware? Please respond so I can made a wiser and thorough understanding than what the doctors says. > Hi, > Has anyone done a triple fusion before? Do you know whether there are > any side effect?. Do you know whether this will cause pain or damage, > due to deterioration of the body as it grows older.. over the age of > 50? or anything you have to beware? Please respond so I can made a > wiser and thorough understanding than what the doctors says. Several people have had it done and talked about in alt.support.arthritis and my memory of them all is that it was an improvement in their way of life. Some of them had to wear a rounded shoe on the foot on the fuse side but that seemed to be easy to adjust to. A person usually has a very painful ankle to have this done but after the recovery,,,, no pain. Harv Thanks Harvey. It is good to hear that after the operation, there is no pain. > Thanks Harvey. It is good to hear that after the operation, there is > no pain. I am sorry but I do not think I said that. AFTER THE Recovery,,,,,, not after the operation. I am sure there is plenty of pain after the operation but that is what the drugs are for. As always,,, something that has to be gone through if you are going to improve the quality of your life. Harv > I am sorry but I do not think I said that. AFTER THE Recovery,,,,,, not > after the operation. I am sure there is plenty of pain after the operation > but that is what the drugs are for. As always,,, something that has to be > gone through if you are going to improve the quality of your life. > Harv Sorry, just typing too rashly without wording my sentence correctly. Anthony Does anyone know if there is any problem caused by a triple fusion, when people get to their 50s and beyond? How long can one walk after an triple fusion operation? At the moment, due to inflammatory arthritis, my friend can only walk 20 mins without stop, and a bit more than 1 hours in total in a day. Would a triple fusion, allows, for example walking 2-3 hours shopping in a city street? Walking as much as a normal person? For people who have done triple fusion, can you do jogging, badminton or swimming? > Does anyone know if there is any problem caused by a triple fusion, > when people get to their 50s and beyond? [quoted text clipped - 11 lines] > For people who have done triple fusion, can you do jogging, badminton > or swimming? Hhhhm, How about climbing Mount Everest or running a marathon? IMO you are going to have to get a grip on your age and your ability to do things. I am sure that swimming would be just fine but the impact of jogging would be a disaster to a newly fused ankle. Will this procedure make you like a teenager again??? Hell no... Will it make you be able to stand or walk on your feet for an extended period of time??? Maybe so and I would be happy with that. Harv > Hhhhm, How about climbing Mount Everest or running a marathon? IMO you are > going to have to get a grip on your age and your ability to do things. [quoted text clipped - 4 lines] > with that. > Harv Just trying to find out to what extend can one walk like a normal person after the operation, and what kind of sports is possible. So that I can assure my girlfriend, that she will have a normal life, if that is in fact factual. My wording one again must have sound like I am hoping I am hoping something unrealistic. But I can just trying to get all the facts for all the positive and negative changes that triple fusion operation can bring potentially. I value the info you provided me for triple fusion. Thanks. Anthony you're not asking unreasonable questions, but the problem becomes one of: a) degree of damage already; done and having to correct for b) actual 'fix' applied when they get in there and actually do the work on it c) any other medical conditions [like the existing r.a., that will influence her recovery, rehab, and overall general health the procedure will give some relief and will give back some mobility and possibly endurance - how much is going to be found out in rehab. think of it this way - if the ankle is fused, and can no longer bend, then you can't walk 'normally' - but you 'can' walk - and can participate in normal activities -but each of us have different capabilities afterwards - a classic YMMV outcome. the alternative would be to continue to have capability diminish and pain increase - so she [and you ] will be glad to have gone thru it, and learn how to maneuver with whatever the outcome ends up being. mind you, i can't have it done because i'm too brittle - but here is my impression: jogging - i wouldn't [jmo] badminton - maybe swimming - YES > > Hhhhm, How about climbing Mount Everest or running a marathon? IMO you are > > going to have to get a grip on your age and your ability to do things. [quoted text clipped - 18 lines] > I value the info you provided me for triple fusion. Thanks. > Anthony On Oct 22, 5:12 am, "Paul T. Holland" <pholl...@bellatlantic.net> wrote: > you're not asking unreasonable questions, but the problem becomes one > of: [quoted text clipped - 23 lines] > badminton - maybe > swimming - YES So, summarizing the opinions so far. As for walking, after a triple fusion, a person will be able to walk much more extensively and possible as much as a normal person. (though the walking style may not be 100% as a normal person would because the ankle is more rigid). Swimming and cycling should be ok. And, perhaps some other non ankle intensive sport. But for ankle intensive sport, better consult with a doctor. Ultimately, how much sports and how much stress one can put to the ankle after the operation is depends on case by case on how healthy was the ankle before the operation and other health factors. Anthony Does anyone know if triple fusion will have any side-effects when old age? I haven't heard much, but does this mean there is none? [Note: Approximately five to 10 percent of ankles fail to fuse,] not old age per se, rather time based wear and tear on the remaining structure: but "the surgery requires the removal of the joint cartilage, proper positioning of the ankle and foot, and placement of screws, plates, rods, or pins to hold the position while the bone knits together into a solid painless structure, so: Once fused, the ankle usually is painless or far improved from the preoperative condition. In most patients, function is somewhat limited by ankle fusion-especially going up and down slopes or stairs, walking on uneven ground, and stooping to pick up objects. Over 10 to 20 years after an ankle fusion, other joints of the same foot tend to wear out and cause pain." 'nother note: if patient is a smoker - STOP - there is a much higher failure rate for the fusion with smokers... "Chronic smoking is a relative contraindication due to the associated high incidence of nonunion" you might want to look at: http://www.emedicine.com/orthoped/topic354.htm "Outcomes are typically good with high union rates of the subtalar and CC joints. The TN joint has the highest incidence of nonunion; however, this decreases with better understanding of the procedure and stable fixation. Degenerative changes at the unfused distal and proximal joints are still a long-term complication, but this is true with any fusion procedure. A study examining 400 triple arthrodesis procedures found less than perfect results in 24.5% of patients (Duncan 1978). Up to 10 months are required for the patient to become pain free (Gellman 1987). Return to high-impact activity is not a given. Lower-impact activities like walking, cycling, and swimming should be obtainable goals postoperatively." > Does anyone know if triple fusion will have any side-effects when old > age? > I haven't heard much, but does this mean there is none? Wow, Paul. You know so much! If I may ask,are you a doctor? On Oct 23, 4:57 am, "Paul T. Holland" <pholl...@bellatlantic.net> wrote: > on uneven ground, and stooping to pick up objects. Over 10 to 20 years > after an ankle fusion, other joints of the same foot tend to wear out > and cause pain." So the problem at old age or after a long time from an operation, is not caused by the triple fusion, but just the natural wear-out of the OTHER parts of joint in the foot then. ? > (Gellman 1987). Return to high-impact activity is not a given. So high stress sports may lessen the life span of the remaining foot joint structure? But from the above, it seems not entirely impossible to do high impact sport? But I guess one should take it as a grain of truth and be caution to whether or not to do high impact sport, and this also depends on case by case and need proper consulting with the arthrithis doctor and foot surgent? lol - no,no - just an old foggy who's been there i'm afraid > Wow, Paul. You know so much! If I may ask,are you a doctor? > [quoted text clipped - 8 lines] > OTHER > parts of joint in the foot then. ? actually mixed message - in and of itself, old age doesn't have to mean that we wear out - but, with less than good nutrition, and poor habits in general, we do. the leg structure [along with the spinal column] is subject an incredible set of stressors just moving us around. if/when we neglect general muscle tone and flexion/flexibility - the 'impact' stress in magnified. and i'm also thinking 'weekend warrior' now - since the hip/pelvis, knee, ankle, foot [sounds like the song!] structure is a continuum, and for the female with the wider pelvic girdle more so - it is normal for there to be wear and tear for those that engage in 'impact' sports: running, jogging, etc, etc - NOW: once the ankle is fused, that 'impact' is going to be transferred from the 3 part section of the ankle, onto/though, the remaining 'normal' foot structure [and 'some] smaller amount back up to the knee and hip] so the wear and tear is going to be reflected in the remaining normal structure and -simply put - wear 'em out earlier than normal - when i gave the range a 10-20 years for this to happen, i should have said that the older you are when you get fused [unless you are in picture perfect shape], the lower the remaining years until you have issues with the foot., so a 50 year old hits the wall faster than a 30 year old. as to ability afterwards? two edged: those who are diligent and work their rehab [after the initial non-weight bearing period - or it won't fuse right!!!] do better than those who are tentative and slack off - but it is going to take months - 10 months isn't unreasonable to get to the new 'normal' only then can a decision about impact sports be made with any reasonable clarity. having a goal is a good thing - but it is going to be a year away...and it has to be built towards over the whole time. each and every step magnifies the forces on the joint - taking a step is one thing, increasing speed, length of stride, surface we are on, etc, at minimum triples the forces - this amounts to many hundreds of foot pounds (3 to 4 times body weight, up to 800+) [no pun intended] on the legs and feet. the triple fusion removes about 40% of the shock absorber the body came with. be looking for a good rehab specialist/sports medicine physiatrist. [not usually paid for by insurance, unless you're a prof. athelete] [aside: many women have shoes with higher heels - forget it after the fusion - ankle won't bend that way anymore, and the arch of the foot doesn't need the added stress] hth paul > > (Gellman 1987). Return to high-impact activity is not a given. > So high stress sports may lessen the life span of the remaining [quoted text clipped - 3 lines] > to do high impact sport, and this also depends on case by case and > need proper consulting with the arthrithis doctor and foot surgent? increased stress [sports] will shorten the life span of the remaining structure, see my next post > On Oct 22, 5:12 am, "Paul T. Holland" <pholl...@bellatlantic.net> > wrote: [quoted text clipped - 43 lines] > > Anthony All sources I found say triple fusion will definitely improve walking. Is there any information or experience from other people out there, that say whether after the operation (with recovery) the person can walk as much/long as a normal person? e.g. assume a normal person do 4 hrs of walking in total a day by going to shopping mall ...etc. Thank you Paul & everyone on the internet!! the improvement is mostly from release of constant pain. with the proviso that this could be as much as a year down the line - and factoring in avoidance of ramps, inclines etc as much as possible [One report showed a 13% decrease in dorsiflexion and a 16% decrease in plantarflexion after fusion - so the remaining foot structure would get strained negotiating inclined surfaces] also, presuming that all three sections 'do' fuse - remember, statistically the TN joint is more problematic than the ST and CC joints then yes, 4 hours spread out over time is reasonable and do-able. also - be sure to look at the actual procedure being contemplated - one bad outcome occurs from nerve damage due to the type of incision [the lateral and medial incisions] some doctors use - familiarize yourself and have a discussion before- post-op, be aware of "entrapments within surgical scar tissue which can take place in the postoperative period; however, painful neuromas rarely occur. When they do happen, standard conservative measures with appropriate medications, injections, and physical therapy should be used. If these measures fail, surgical neurolysis or proximal neurectomy with implantation into muscle is performed." > All sources I found say triple fusion will definitely improve walking. > Is there any information or experience from other people out there, [quoted text clipped - 4 lines] > > Thank you Paul & everyone on the internet!! Dear Paul, I seems to see from what you wrote that inherently triple fusion does not bring "side-effects" for people when they become old age eventually. But because the limit on the degree of freedoms on the joints, it might(will?) accelerate the natural wear-and-tear of the other joints in the foot. Do you know if this acceleration is significant? Like double the natural wear-and-tear, or 5% more and so on? Anthony > Dear Paul, > [quoted text clipped - 4 lines] > might(will?) > accelerate the natural wear-and-tear of the other joints in the foot. the increased wear and tear 'is' a side effect of having the cartilage of the three ankle joints removed and the bone fused. this is a classic YMMV situation - no two outcomes will be the same, so it can only be viewed by reviewing the conditions: overall condition of the 'other' leg/foot structures at time of fusion, state of overall health of patient, any other contributing/ongoing disease processes like R.A. degree of 'take' of the 3 fusion sites VERY IMPORTANT: quality and length of post-op rehab continuing level of activity that may affect the fused joint(s) after full healing and rehab some R.A.'s [small number] have had post-op avascular necrosis of some of the bone ends - this appears to be from the auto-immune process, some have had increased scarring of tendons/ligaments that required 'release' surgery later. > Do you know if this acceleration is significant? Like double the > natural wear-and-tear, or 5% more and so on? several things are primary influences any ongoing medical condition that affects soft tissue or bone - like RA or other auto-immune processes. the degree of whatever condition will likely accelerate any further breakdown follow-up after healing for proper footwear - possibly even othotics or special order/built shoes appropriate for activity level age at time of fusion degree of ongoing activity and what surfaces this is done on bottom line is that since damage has already occurred for whatever medical reason, 'and' this patient is very likely to want to, and will, be active afterwards - yes, there probably will be some accelerated breakdown of the rest of the structure. how fast and to what degree would be pure blue sky guess. > Anthony Hi Paul, I heard some doctor said triple fusion will cause bone density to deteriorate when people become of old age (over 50), and this cause shrinkage to the bone which result in pulling of the flesh/tendon or other part of the foot/ankles.(??) Have you heard anything remotely like this?? Anthony >> Dear Paul, >> [quoted text clipped - 53 lines] > >> Anthony > Several people have had it done and talked about in alt.support.arthritis > and my memory of them all is that it was an improvement in their way of [quoted text clipped - 3 lines] > ankle to have this done but after the recovery,,,, no pain. > Harv Thanks Harvey. It is good to hear there is no more pain after such operation. |
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