Arthrodesis of the mixed knee joint using a plate. Arthrodesis of the knee joint: varieties, indications for surgery, rehabilitation

Diseases of the joints in the last stages always affect their mobility, on which, in principle, the vital activity of the organism depends. In the later stages, there is only one treatment option and that is surgery. Arthrodesis, what it is and how it is carried out in this or that case, few people know, but sometimes it is the only way to restore the ability to support a person.

Arthrodesis: salvation or a step to nowhere?

The essence of arthrodesis is to completely immobilize the diseased joint. Many will think, what is good about this? After all, a person will no longer be able to move fully as he did before, but, alas, sometimes his life and a problematic limb can only be saved in this way.

There may be several reasons for the loss of support ability, sometimes this happens as a result of improperly fused fractures that affected not only the bones, but also the joints. This can happen as a result of a complication of tuberculosis, as well as other acute and chronic inflammation joints.

The process consists in completely removing the cartilaginous tissue at the site of the joint, after which the surfaces of one and the other bone are securely fixed and given time for them to grow together. As a result, the bones will not rub against each other, creating unpleasant, and most often painful sensations, but will rather resemble one solid bone. To speed up the process, a compression method is used, which allows, by squeezing the articular ends with a special apparatus, to achieve the fastest results.

Ankle joint

One of the most famous operations of this kind is the arthrodesis of the ankle joint. In most cases, such an operation is performed after or during the treatment of purulent osteoarthritis. In the process of arthrodesis, the doctor connects the tibial and talus, in this case, the entire infected part is removed, and it is with the bone that they work.

With such a disease, the patient feels pain well, which not only gives him some discomfort, but sometimes prevents him from moving. After the arthrodesis, the pain disappears, but this happens gradually, because the operation will have its consequences. It is worth remembering the problem that will appear after this - the patient will not be able to move his leg as he did before, because the place of fixation of the two bones will be completely immobilized.

Inadequate care of the affected leg after arthrodesis leads to recurrence at the surgical site purulent process. And if before the operation it affected the area of the joint, the area where the bones were connected, then in its absence, the process occurs simply in the area where the bones were connected.
To avoid this, it is necessary to carefully monitor the wound that has appeared and protect this place as much as possible from contact with any microorganisms. After the operation, the doctor in such cases prescribes a number of antibiotics that contribute to this.

In addition, there is an operation that ranks first in terms of prevalence, it is similar to the treatment of the ankle, but has its own characteristics. It is called "corrective arthrodesis of the ankle joint." In this way, deforming osteoarthritis is sometimes treated. The main task in the treatment process is the stability of the joint after it has been completely immobilized.

Today, there are 4 practical methods that allow you to achieve such results: extra-articular, intra-articular, combined, compression.

The process is simple in theory but more complex in practice. The doctor's task is to remove all parts of the tissue in the affected area that have been affected or have succumbed to changes. Then, the usual process for arthrodesis is carried out, and after 3 months, using an X-ray, it can be determined whether the bones have grown together or not. If everything is in order, then plaster is applied to the problem area for another 3 months, after which the treatment process will be completed.

Knee-joint

Usually arthrodesis knee joint is prescribed if the patient has been diagnosed with deforming arthrosis. Indeed, in addition to the fact that this disease creates problems within the body, in addition, it is also accompanied by unbearable pain, and such sensations practically stop the process of movement.

Osteoarthritis of the knee joint usually has three forms of the course of the disease. And if the first two can be treated conservatively, and sometimes even prescriptions are effective traditional medicine, then the latter needs only surgical intervention.
With such a disease at an advanced stage, cartilage tissue is absent and provides direct confirmation that the patient needs arthrodesis. Indeed, in the vast majority of cases, at the last stage, it is no longer possible to build up cartilage tissue.

subtalar joint

Arthrodesis of the subtalar joint is done only if the diagnostic results show that inaction will lead to disability. The reason for the operation may be deformity of the feet or clubfoot, arthrosis of the talonavicular joint. And if in everyday life a person can notice some of these changes, not counting arthrosis of the talonavicular joint, this does not mean that he needs to rush to take a seat on the operating table. Only in serious and advanced cases, the patient will need surgery. This usually occurs in situations where it is painful for a person to walk, and the supporting function of the foot is almost lost.

Arthrodesis helps to get rid of defects and eliminates pain, which almost never leaves the patient. And if the talonavicular joint is damaged, such symptoms can appear even at a young age. As in the case of other similar operations, rehabilitation takes several months in time. A positive result of the operation is considered when the pain does not bother the patient when walking about 4-5 km, if there is no difference in the length of the healthy limb and the one on which the operation was performed. Also, the operation is considered successful if the patient switched to regular shoes and does not feel discomfort, and from a cosmetic point of view, the legs practically do not differ from each other.

Lisfranc joint

Changes and injuries in the Lisfranc joint are usually associated with fractures and dislocations. metatarsal bones. Most of these injuries occur in men between the ages of 20 and 30.

This usually occurs as a result of an accident, it can also be a sports injury, as well as an unsuccessful jump or fall from a height.

Arthrodesis of the Lisfranc joint will differ depending on the level of damage. But problems in the treatment of such a change are extremely rare; a young organism additionally affects the course of recovery, which is prone to regeneration and the speedy restoration of body functions.

Problems with the spine

Arthrodesis in the spine is performed only in selected cases, since certain vertebrae will be immobilized during the treatment. Treatment of the spine in this way helps to get rid of back pain. In addition, arthrodesis in the spine area allows you to increase your working capacity, which has decreased due to illness. Sometimes problems may concern the head of the rib, then the treatment process will already be somewhat different.

The process of arthrodesis of the spine itself lasts several hours and can be performed different methods if the operation touches the head of the rib, completely different methods may be used.

The first option for treating the spine is to have the patient's own bone become a graft, which will connect the vertebrae and stimulate bone growth. There is also a spinal treatment option, when metal implants are used, they fix two vertebrae until the bones grow together.

Arthrodesis in the region of the spine is also called "spondylodesis". To use this spinal treatment option, there must be a number of indications, these may be fractures, hernias, displacement of the vertebrae, or infections of the spine. Arthrodesis is used in the presence of problems in the rib area.

disability after surgery

No matter how good arthrodesis is, but with the wrong approach to treatment, you can get disability. The fact that a patient can get a disability while still in the process of treatment is no secret to anyone. This is due to the fact that recovery after surgery can last for months, it is during this period that disability may occur, when a person himself is not able to fully take care of himself.

Arthrodesis on any of the joints will give partial disability, because the joints will not move as before. And accordingly, the patient will not be able to perform some of the functions that were previously available to him.

If you decide to apply for disability after such an operation, then talk about 100% certainty in obtaining it is impossible. Since a positive or negative result depends on the degree of damage and the problems that arose after the operation.

2016-10-07

Ankle joint
subtalar joint
Corrective ankle joint
knee joint

Arthrodesis is an operation, the meaning of which is that the joint affected by a particular disease is completely immobilized. This is done in order to return the limbs to the lost support ability. Most often, the procedure is performed in the presence of a dangling joint, with an existing contracture and other pathological conditions- severe pain in arthrosis, the consequences of paralysis, bone tuberculosis.

Arthrodesis of the ankle joint

Most often, arthrodesis of the ankle joint is performed, which is most often performed in the treatment of purulent osteoarthritis. The operation is based on the complete removal of the affected part, after which the two bones - the tibia and the talus - are compared with each other and are well fixed.

If before the operation the patient felt a strong pain syndrome, then after it it completely disappears, however, this takes some time. However, there is one significant disadvantage- the procedure involves the complete fixation of the bones, which means that this place on the human body will become immobile.

In this case, the consequences include a repeated relapse of the purulent process, but without the participation of the joint. It begins to develop at the junction of two bones. To avoid this, it is necessary to carefully monitor asepsis and antisepsis during the procedure and prevent microorganisms from entering the wound. In the postoperative period, antibiotics are used.

Arthrodesis of the subtalar joint

It is performed in the case when there are lesions that can lead to disability. Firstly, these are painful fractures and fracture-dislocations, which are especially dangerous in the presence of arthrosis of the talocalcaneal joint. Secondly, these are all kinds of orthopedic diseases - valgus or varus deformity of the feet, clubfoot. At the same time, the patient is constantly worried about pain and loss of the supporting function of the foot. The essence of the procedure is to get rid of the signs of deformity and to stop the pain syndrome, as well as to restore the efficiency of the foot.

Depending on the severity and degree of damage, the period of immobilization and the rules for the rehabilitation of patients after undergoing arthrodesis are established.

A positive result from the operation is not evaluated immediately, but only after a few months. These factors include:

Absence of pain at rest and when walking at a distance of 4 to 6 km.
Shortening of the limb does not exceed 3 cm or is completely absent.
Use of regular shoes.
Good cosmetic appearance of the lower leg after surgery.

Corrective arthrodesis of the ankle joint

It ranks first in popularity. It is followed by an operation hip joint. This is one of the possible treatment options for deforming osteoarthritis. The main thing here is to achieve stability of the joint with its complete immobility.

Today, four methods are used in practice:

Intra-articular.
Extra-articular.
Combined.
compression

The essence of the procedure is that all tissues that have certain changes are removed from the affected area. After that, the bones are connected in such a way that later their fusion is possible. If the head femur and part of the neck are non-functioning, they also have to be removed. After the operation, the patient is put in a plaster cast. She has not been removed for 3 months.

After the plaster is removed, an x-ray is taken, and if all the bones have grown together correctly, a new plaster is applied for another 3-4 months.

Arthrodesis of the knee joint

An operation that is performed in the most critical cases. The first indication for use is severe deforming arthrosis with severe pain and limb deformity. The second indication is instability of the knee in the presence of paralysis of the thigh muscles.

After the operation, a bandage is applied to the leg, which is removed after complete fusion of the bones. Rehabilitation depends on individual features and should be carried out in a specialized medical institution.

Arthrodesis of all joints, including the foot, has its own contraindications, which must be taken into account. These include:

Children's age up to 12 years.
The patient's age is over 60 years.
The risk of suppurative processes at the site of surgery.
Fistulas of non-tuberculous origin.
Severe condition of the patient.

That is why the operation can be performed only after a thorough examination and the presence of those indications, and especially the pain syndrome, that cannot be treated with drugs.

The goal of all orthopedic surgeries is the complete or partial return of the lost function to the musculoskeletal system. Over time, this group of interventions has been continuously developed, giving more and more physiological results. With the advent of new polymeric materials, arthroplasty has become available - installation internal prostheses in any part of the skeleton.

This method has found maximum application in the treatment of arthrosis of the knee joint, when conservative methods are already ineffective. Previously, in this case, all patients underwent palliative surgery - bone resections or arthrodesis. But their consequences were deplorable - although the patient got rid of the pain in the joint, in return he practically lost mobility in it.

Endoprosthetics of the knee joint can eliminate not only the symptoms of arthrosis, but also proper rehabilitation fully restores the functionality of the joint. Now this technique does not stand still - there are new options for interventions and varieties of prostheses. Therefore, for every patient there is individual approach, allowing you to choose the optimal type of operation.

concept

All people have heard about knee prosthetics at least once in their lives - but what is it? In the mind of an ordinary person, an image immediately pops up in which the articulation is completely replaced by an artificial likeness. But when they see the patients after the operation, they notice only a scar on the skin - outwardly, the knee remains the same. A natural question arises - where is the prosthesis?

Endoprosthesis replacement of the knee joint just carries such a goal - the elimination pathological changes with minimal consequences. Therefore, just one operation performs three tasks at once:

It allows you to get rid of the main symptom of arthrosis - pain, which in the later stages becomes permanent. Eliminates her main reason- destroyed articular surfaces, which are a source of continuous inflammation.
The ability of the limb to perform the support function is restored quite early. Due to this, the load on other joints of the lower extremities and the spine becomes uniform, preventing their compensatory overload.
The special physiological structure of the knee joint prosthesis ensures maximum restoration of mobility in the joint. This feature does not allow the muscles and ligaments surrounding the knee to atrophy, creating conditions for their constant work.

The effectiveness of knee joint prosthetics depends on several factors - the duration of arthrosis and the causes of its development, the age of the patient, comorbidities, the duration and usefulness of rehabilitation measures.

Types of endoprostheses

In the production of prostheses, only materials that are resistant to constant stress and do not cause an inflammatory reaction of the body are used. Now a combination of metal (an alloy of steel with cobalt and chromium) and a polymer - high molecular weight polyethylene is used. Together they form an ideal pair for friction, requiring no additional lubrication.

Since almost all prostheses are made of the same materials, the differences between them are only in structure. According to this principle, only two varieties can be distinguished:

A total knee replacement involves the complete replacement of the articular surfaces of the femur and tibia. In this case, the altered cartilage, together with the underlying bone plate, is removed, and a metal analogue containing polymer inserts is installed in its place. Also, the inner surface of the patella, which is fixed to the femur, is replaced separately.
A partial endoprosthesis involves replacing only that part of the joint that has undergone the greatest degenerative changes. Therefore, there are separate condylar prostheses that provide correction of disorders only in the outer or inner half of the articulation.

Varieties do not have a significant advantage over each other - each of them is used for individual clinical options arthrosis.

Advantages

The wide distribution of this type of operations is due to its uniqueness - a difficult, at first glance, intervention results in continuous positive results. Unlike predecessor techniques, knee arthroplasty has the following advantages:

The possibility of early activation of patients allows to accelerate the start of rehabilitation measures as much as possible. When a person begins to move fully a few days after the operation, this automatically speeds up the recovery processes in his body.
Early load on the lower limb and restoration of mobility in the operated joint do not leave the muscular and ligamentous apparatus without work. In a short period of time, they do not have time to develop atrophic changes that slow down the return of mobility in the joint.
A good long-term prognosis is due to the possibility of permanent modification of rehabilitation measures. Therefore, even with slight mobility immediately after surgery, joint function can be fully restored after a few months.

Operations of bone grafting and arthrodesis, the forerunners of arthroplasty, gave only a symptomatic effect, depriving a person of mobility in the knee joint.

Indications

Different structures of prostheses, respectively, are used to treat certain forms of the disease. Unicondylar knee replacement is indicated when the following factors are combined:

Deforming arthrosis of the second or third stage, in which there is a lesion predominantly of the internal or external section of the articulation.
Severe pain syndrome, leading to a significant decrease in the daily or professional activity of the patient. In this case, the pain cannot be eliminated with the help of conservative therapy.
The age of the patient must be at least 55 years.
The ligamentous apparatus should not be changed by pathological processes, but varus or hallux valgus joint should not exceed 15 degrees.

Total knee arthroplasty has slightly different indications, which is caused by a large amount of intervention. Therefore, its implementation is indicated only with the following signs:

Expressed degenerative changes in all departments of the joint, which are accompanied by a significant violation of its mobility.
Intense and persistent pain syndrome, which cannot be stopped while taking several combinations of painkillers.
Angular deformities in the joint exceeding 15 degrees, as well as flexion or extension contractures that are not amenable to conservative correction.
The patient must be over 60 years of age.

The intervention carries a high risk of early and late complications, therefore, when planning it, all factors that can lead to an unfavorable outcome are taken into account.

Contraindications

All medical withdrawals from the operation are divided into two groups, according to which further tactics of patient management are selected. Absolute contraindications completely exclude prosthetics at the moment:

Spicy inflammatory process in the patient's body, leading to the formation of a systemic reaction. The main criteria for this are the detection of a pathological focus and symptoms of fever.
Acute superficial thrombophlebitis and deep vein thrombosis were singled out as a separate group. Moreover, its localization does not matter - both on a healthy and on an operated limb.
Lack of active extension in the knee joint associated with damage to the ligamentous apparatus or atrophic processes in the muscles of the thigh.

Relative contraindications do not prohibit the intervention, but may delay its timing. Typically, this period is used to treat an identified disease or condition:

Osteomyelitis of the femur or tibia in the joint area, as well as active or transferred purulent arthritis. At the same time, doctors wait at least 12 months, observing their course and taking therapeutic measures.
Trophic ulcers on the lower leg caused by varicose veins or atherosclerosis of the arteries of the lower extremities.
Any inactive foci chronic infection in the body to be eliminated.
Large scars in the area of the knee joint, soldered to the surrounding tissues.
Any chronic disease internal organs with an uncontrolled course, as well as mental illness.
Previously performed arthrodesis of the knee joint in a functionally advantageous position.

Such an attentive attitude to contraindications is due to the high risk of complications that develop mainly in the early postoperative period.

Technique

In fact, the intervention does not contain any complex techniques, and all the severity is associated only with its significant volume. The operation is quite lengthy, and is also carried out under general anesthesia. In fact, it can be divided into three main stages:

First, a wide access to the joint cavity is made, after which the altered articular surfaces and synovial membranes begin to be removed. The underlying bone plates are also partially destroyed to ensure complete fixation of the prosthesis.
When platforms are formed in the region of the condyles and the articular surface, they are evaluated. Additionally, some interfering parts of the bone are removed. Then the prosthesis is securely fixed in the selected position using a special polymer adhesive - cement.
The last step is plastic surgery of the ligaments and soft tissues around the joint, which allows creating a reliable support for the newly formed joint.

The main problem of the operation is still a wide skin access, which significantly slows down the patient's recovery.

After the intervention

For maximum reduction the risk of complications in all patients after arthroplasty are carried out preventive actions. They are aimed at preventing the development of the most common situations - inflammation or venous thrombosis:

The appointment of antibiotics before and after surgery reduces the likelihood of infection in the joint cavity. Especially dangerous is the primary chronic course inflammation, which can lead to rejection of the prosthesis.
Anticoagulants are also used for the entire early postoperative period to reduce the risk of formation acute thrombosis or pulmonary embolism.
Additionally, non-drug measures are applied to the patient - early activation (already on the second day), elevated position of the legs in bed, use of elastic stockings or bandaging.

If the patient has concomitant diseases, then after the operation they are also monitored for their course and preventive therapy.

Rehabilitation

Thanks to the artificial restoration of the articular surfaces, the conditions for early activation are created in patients. To adapt the muscles and ligaments to the "new" joint, it is required to put them into work as soon as possible. Therefore, physiotherapy exercises become the leading method of rehabilitation in such patients:

Gymnastics classes begin on the first day after the intervention, and include general strengthening exercises in bed.
From the second day, patients are allowed to exercise axial load on a limb - getting out of bed, as well as walking with crutches.
Within two weeks, the load on the operated joint should gradually increase - using crutches as support, the patient should slowly lean on the leg more and more.
When the sutures are removed from the postoperative wound (approximately on the 14th day), the rehabilitation program becomes more active. It includes exercises that allow you to strengthen the muscles of the thigh, as well as completely restore the range of motion in the joint.
From now on, patients should completely get rid of crutches, replacing them with a cane when walking. It is used for support purposes for about 6 more weeks, after which the person begins to walk without orthopedic aids.

Of auxiliary importance are various procedures physiotherapy - dry and water massage, electromyostimulation, mechanotherapy and hydrokinesiotherapy.

Recovery time

After completion of rehabilitation, the patient does not leave medical supervision in order to avoid the formation of late complications. The most convenient method for assessing the condition of the prosthesis is an X-ray examination:

During the first year after the operation, AP and lateral images of the joint are taken at 3, 6 and 12 months after the intervention.
Then, for 5 years, the patient must undergo a similar examination annually.
In the absence of complications during this period of time, we can talk about a favorable outcome of the operation. But still, radiography of the knee joint should be performed once every 5 years for dynamic monitoring of the state of the prosthesis.

The instability of the endoprosthesis is the most common late complication that doctors fear. Moreover, it is almost impossible to carry out a full-fledged prevention of its occurrence. Therefore, they try to identify instability as early as possible in order to take timely measures to correct it.

- surgery, as a result of which the joint is fixed in a functionally advantageous position and becomes immobile. The operation is performed with dangling joints, some types of arthritis and severe deforming arthrosis. The intervention is performed with excision of the surfaces of the joint, with fixation of the femur and tibia outside the joint cavity, or by a combination of these techniques. It is carried out according to plan in the conditions of the orthopedic or traumatology department. Provides long-term immobilization in the postoperative period.

Indications and contraindications

The list of indications for arthrodesis includes severe deforming arthrosis with severe pain and impaired support function, spastic flexion contractures, dangling joint with paralysis of the thigh muscles, post-tuberculous changes in the knee joint, and some types of arthritis. The list of contraindications includes an active infectious process in the joint, pustular lesions of the skin and soft tissues of the limb, decompensated therapeutic diseases, acute infectious diseases. When deciding on an operation, the possibility of arthroplasty should be considered as a more functional method for eliminating existing disorders (taking into account the characteristics of the existing pathology).

Arthrodesis of the knee joint is practiced in traumatology for a number of pathologies that are accompanied by dysfunction lower limb or a strong pain syndrome, which negatively affects the quality of human life.

During surgery, deformable cartilage tissue and non-viable elements are completely removed, and implants are installed in their place. different materials: synthetic and metal, auto-bone, donor or taken from the body of the operated tissue.

It is important during the operation to fix the limb in a statistical position (5-10 degrees), which ensures optimal fusion of the tibia with the patella. The essence of the technique is to remove the affected tissues.

In orthopedics, several types of surgical treatment are used:

intra-articular - removal of cartilage, growth tissues are not affected;
extra-articular - cartilage is not removed, and fixation is performed using a bone implant;
mixed - after resection of the cartilage, the bones are connected and fixed with bone, synthetic or metal fixators;
compression - is used extremely rarely, it consists in squeezing the surfaces of the joints.

The process of the procedure

Training

At the preparatory stage, full examination patient.

Immediately before the event, a cleansing enema is shown. No food should be taken 10 hours before surgical intervention, and the liquid - in 4-5 hours.

Arthrodesis of the knee joint

The intervention is performed through a transpatellar or U-shaped incision. In this case, the leg is fixed in a stationary state. After opening, the kneecap ligament is grasped with a hook and pulled back. A cartilage excision line is outlined, which are then removed along with part of the bone and cruciate ligament. After resection, the position of the leg is changed to determine the level of contact of the bone surfaces. After the introduction of the lower edge of the patella into the groove of the upper (made artificially), the ligament is sutured to the tibia, sutures and a plaster cast are applied. Thus, ankylosis is a connecting structure from the fusion of the kneecap, femur and tibia.

rehabilitation period

For 4-5 weeks it is necessary to observe bed rest. After this time, short movements with the help of a stirrup are allowed. The plaster is removed after 3-4 months, replacing it with a splint, an x-ray is taken. If there are no contraindications, you can slightly load the leg, do LKF, and other rehabilitation procedures.

The splint is removed after the control X-ray, if complete fusion is noted.

Indications

Intervention is prescribed for such pathologies:

improperly fused fracture;
pathological dislocation;
contractures;
arthrosis and deterioration against its background;
consequences of childhood paralysis;
tuberculous arthritis.

Contraindications

The technique is not prescribed for children under 12 years of age and people over 60 years of age, as well as with such pathologies:

fistulas of nontuberculous origin;
general weakness, exhaustion;
local skin lesions, inflammation, suppuration.

Complications

Possible consequences:

infection and inflammation of the wound, its long healing;
pain at the resection site;
leg swelling;
thrombosis, thromboembolism, thrombophlebitis;
gait disturbance.

Prices and clinics

The service is provided by a traumatologist-orthopedist in specialized clinics in Moscow.