In severe cases of arthritis of the big toe joint, fusion surgery may be necessary. The gold standard treatment for end-stage arthritis is a surgical procedure that locks the great toe joint up and is called a “fusion” or “arthrodesis”. This blog post will discuss what you can expect from this type of surgery as well as the risks and benefits associated with it.
What is joint fusion surgery and how does it work?
This is a surgical procedure that locks the great toe joint up and is the gold standard treatment for end-stage arthritis. The surgeon fuses your big toe joint to eliminate pain, correct deformity, allow you to walk normally again, and improve the function of your foot. The remaining cartilage in the joint is removed and your body is tricked into thinking there is a fracture at the joint that heals as one solid piece of bone in an optimal biomechanical position.
Why choose surgery as a treatment for arthritis-related pain
A joint fusion is not always the first choice of procedure for arthritis in the great toe joint. There are other options available including medications, injections, and other conservative treatments such as shoe inserts/orthotics. It is also important to modify your activities because any maneuver that requires increased dorsiflexion (upward motion) of the joint causes more pain. Examples would be pushups, lunges, and kneeling while gardening.
Another excellent surgical procedure used for earlier cases of arthritis is a clean-up of the joint. This is called a cheilectomy. This procedure can be performed either through an open approach with an incision placed on top of the great toe joint or through a minimally invasive technique with one or two smaller incisions. This procedure allows for the removal of a painful spur on the top of the joint. The spur typically is a source of pain and can reduce the upward motion of the joint. If the spur is removed, motion can be restored to a certain extent and pain relief can be attained. A cheilectomy has excellent outcomes but patient selection is critical. A cheilectomy will not fix any arthritis in the joint. It is possible for arthritis to progress and another procedure, like a fusion, may be needed down the road if it becomes bothersome enough.
Procedure
This procedure is performed in the operating room typically with sedation and local anesthesia in the foot. Patients go home the same day. A tourniquet is used to control any bleeding and the foot is prepared in a sterile fashion. The skin over the big toe joint is then incised and the joint is exposed and examined. This is the point where the extent of arthritis can be visualized. The surgeon will remove all of the inflamed synovium (joint lining) and cartilage within the joint. A small metal plate with screws may be placed across the joint to keep the big toe in a nice position while it heals. This helps to keep everything stable while it heals. Once the procedure is complete, the surgical site is cleaned with sterile saline, and sutures are placed to close the incision.
The surgery usually takes between one and two hours, but this may vary depending on your situation. After surgery, you will be taken to the post-operative area where you will remain until you are awake, alert, and safe to go home with your friend or family member.
Post-operative instructions
It is important to follow all your surgeon’s post-operative instructions to optimize your healing and prevent complications from occurring. Most patients do benefit from a short course of non-weight-bearing to the foot after surgery because this can protect the incision, decrease the amount of swelling and pain that develops.
A surgical shoe or boot is used for about 6-8 weeks post-op and the fusion site is tracked with x-rays performed in the office.
Typically, baseline activities can be resumed around 12 weeks post-op but there can be some continued swelling and discomfort for months after surgery.
Frequently Asked Questions about Joint Fusion Surgery
How do I know if I am a good candidate for fusion surgery?
A fusion procedure is recommended to patients that are healthy enough to heal the procedure. Certain medical conditions like peripheral vascular disease, diabetes mellitus, osteoporosis, and Vitamin D deficiency can increase the risk for postoperative complications and these concerns should be addressed and discussed with your surgeon. Patients that do well with fusion surgery have exhausted conservative treatment options like activity modification, orthotics, and injections and continue to have pain and disability. This procedure is normally recommended to patients with very bad arthritis in the toe joint or if they develop pain after having undergone a cheilectomy (clean-up procedure).
What is the typical recovery time?
Most patients do well and have a speedy recovery. However, everyone heals differently and you should expect some swelling and discomfort for months after surgery. Activities can typically be resumed around 12 weeks post-op but check with your surgeon to get their specific recommendations.
Can I go back to work after surgery?
Each patient’s situation is different so it is best to check with your surgeon about their recommendations. In general, most people can return to desk jobs approximately two weeks post-op but may need more time off if they have a manual labor job. Again, each case varies so please speak with your doctor.
Will I need physical therapy?
It is typically not necessary to attend physical therapy after this procedure.
Are there other situations where a fusion might be recommended?
Yes. This is a good procedure for patients that have really large bunion deformities. Some patients with connective tissue disorders like Ehrlos-Danlos-Syndrome would also benefit from a fusion procedure to correct a bunion because there is so much ligamentous laxity in this medical condition and a normal correction would have a higher rate of recurrence.
What about joint replacement?
These implants typically do not hold up very well over time and if a fusion ultimately needs to be performed, it will make the revision procedure more challenging with a longer recovery and need for bone grafting.
Risks of Joint Fusion Surgery
The risks of this type of surgery include infection, blood clots, nerve damage, and failure of the fusion. However, when performed by a qualified surgeon, these risks are lower because your doctor needs to determine whether you are a good candidate for this surgery. The benefits of joint fusion surgery include elimination of pain, correction of deformity, and ability to walk better.
If you have end-stage arthritis in your great toe joint, fusion surgery may be the best option for you. This procedure will fuse the joint of the big toe to ease pain and allow more mobility. Do you suffer from this condition? Give us a call today for an appointment so we can discuss treatment options that are right for you!