Home   |   Search   |   Site Map   |   



Tiffany-DogTarsal Arthrodesis is a surgical elimination of joint motion and, ultimately, bony fusion of joint surfaces. Tarsal arthrodesis is considered a salvage procedure for patients in which other surgical or medical treatment will not restore normal, pain-free joint function. It can relieve pain and restore reasonable limb function.
 
Surgical Anatomy of Tarsal (Hock) Joint:Dog-Hock-Anatomy
  • The hock is compound joint comprising the distal tibia and fibula, the seven tarsal bones, and the proximal metatarsal bones.
  • The proximal row of tarsal bones comprises the talus and the calcaneus, on which the Achilles apparatus inserts.
  • On the medial aspect of the distal tarsus, there are two rows of bones with the central tarsal bone being positioned between the talus and tarsal bones.
  • On the lateral aspect there is only one bone, the fourth tarsal bone.
  • The proximal intertarsal joint comprises the talocalcaneocentral joint medially and the calcaneoquartal joint laterally.
  • The centrodistal joint is the joint between the central tarsal bone and the tarsal bones 1-3.
  • The tarsometatarsal joint is restricted by the numerous ligaments of the tarsus. The most massive of these are the plantar ligaments, which arise from the sustentaculum tali, plantar body, and distal lateral calcaneus and pass distally to insert on the fourth tarsal bone, the othere distal tarsal bones, and the metararsal bones.
Indications:
  • For surgical fusion of the tarsal joints include end-stage degenerative joint disease, chronic or irreparable articular fractures, intra-articular malunions, or nonunions, and servere  joint instability due to loss of ligaments and or bone that cannot be reconstructed successfully.
Tarsus-Dog



Surgical Procedure Options for Tarsal Arthrodesis:
  • The tarsal joints can be fused by a pantarsal arthrodesis or a partial tarsal arthrodesis.
  • When the entire joint is destroyed or diseased, a pantarsal arthrodesis is clearly indicated.
 
“Pantarsal arthrodesis is used to treat talocrural pathology or irreparable injuries to the entire hock joint.”
 
Partial tarsal arthrodesis seems to be preferable to a pantarsal arthrodesis because motion and function of the unaffected to joints can be preserved. It is the method of choice for fusion of the intertarsal or tarsometatarsal joints.
 
“Partial tarsal arthrodesis is used to treat luxations or subluxations of the intertarsal and/or tarsometatarsal joints.”
 
  • If the talocrural (tibiotarsal) joint is destroyed, panarthrodesis is usually preferred to a partial arthrodesis of the talocrural joint.Dog-Tarsal-Joint
 
Pantarsal arthrodesis:
  • The joints are exposed and the articular cartilage is thoroughly removed to the level of subchondral bone.
“The articular cartilage is thoroughly removed, by shaving or by osteotomy, to the level of subchondral bone, preservation of the normal joint contours by shaving the cartilage is usually preferred.”
 
  • If the end of the tibia is sclerotic, holes can be drilled through the subchondral bone into the medullary canal to create vascular access channels.
 
“Autogenous or Allogenous cancellous bone graft is used to encourage early bone healing.”

 
  • Functional alignment of the limb is important for a good outcome. The recommended angle for arthrodesis is 135-145° for dogs and 115-125° for cats. It is best to carefully observe the animal preoperatively to determine the optimal angle of fusion for each particular patient.
 
“The recommended angle of tarsal arthrodesis approximates 135-145° for dogs and 115-125° for cats.”

Dog-Tarsal-Subluxation

 
  • Rigid stabilization of the tarsus is required to achieve predictable bony fusion and to allow for early weight bearing.
  • Plates and screws have proven very successful and are most widely used. Excellent results can be achieved with dorsal plate placement.
 
“ Plates and screws have proven very successful for pantarsal arthrodesis.”
 
  • The plate is centered over the distal tibia, the talus and the third metatarsal bone.
  • The size of the plate is determined by the size of the largest screw that can be inserted in the third metatarsal bone.
  • A minimum of two screws should be placed through the plate holes into the talus and calcaneus.
 
“Incorporation of the calcaneus with  at least two screws in the fixation is important to achieve complete and pain-free fustion of all joint levels.”


 
Talocrural arthrodesis
  • A partial arthrodesis of the talocrural joint is not recommended and panarthodesis is preferred.Hock-Partial-Arthrodesis-Dog
  • If circumstances do require and isolated fusion of the talocrural joint, the calcaneus has to be incorporated in the fixation.
  • This is usually achieved with two or three lag screws crossing the talocrural joint in including the calcaneus.
 
Arthodesis of the intetarsal and tarsometatarsal joints
  • Partial arthrodesis of the intertarsal and tarsometatarsal joints may be performed with the plates, tension band wiring, or lag screws.
  • The cartilage of the affected joints is removed and cancellous bone graft packed in all cases.
  • A lateral plate extending from the calcaneus down to the midshaft of the fifth metatarsal bone can be used to arthrodese both intertarsal and tarsometatarsal joints.
  • A plate of sufficient length for three screws to be inserted in the calcaneus and three screws in the metatarsus is selected.
  • For fusion of the centrodistal and/or tarsometarsal joints, one or two short plates can be use.
  • They are either placed on the dorsal side of the affected tarsal bones, the medial side of the central second tarsal and/or second metatarsal bone or the lateral side of the fourth and fifth metatarsal bone.`
Postoperative Care after Tarsal Arthrodesis:
  • Postoperative radiographs are evaluated for limb alignment and implant placement.
  • A modified Robert Jones bandage is applied postoperatively to control bleeding and swelling.
  • External cast or splint is usually recommended for 6-8 weeks during the healing phase, in all cases stabilized with internal fixation.
  • The padding of the cast or splint is changed every  week
  • Follow up radiographs may be taken at 4 and 8 weeks intervals to evaluate the progression of the arthrodesis.
  • The animal should be confined, with activity limited to leash walks, until bone healing is complete.
  • Proper Pain management is important.
  • Resuming full activity and exercise will be determined in most cases by the radiographs taken at 6- 8 weeks after the surgery.
  • After the cast has been removed, exercise is gradually increased on a leash over the next 6 weeks; during the first week a 5 minute walk twice daily is permitted; the walks can be increased by 5 minute increments each week until a normal amount of walking has been achieved
  • Recheck immediately if your pet suddenly starts using their leg less than before.
 Post-op-Splint
Potential complications & Risks:
  • As with any surgical procedure, complications can occur.
  • Anesthetic death is very uncommon with our advanced anesthetic monitoring devices and advanced anesthesia protocols
  • Infection is possible but very uncommon
  • Cold sensitivity requiring removal of the plate and screws after a year
  • The most common complication is delayed healing, where, despite our best efforts to reduce and stabilize the joint, individual patients respond slower than others.
  • In other cases, the bone may refuse to fuse and require additional procedures like bone grafting
  •  Implant failures, such as breakage or loosening. Lack of joint fusion, and ostemoyelitis are occasionally seen.
  • Lack of rigid fixation seems to be the most important factor leading to complications. In stability causes delayed fusion of the joint. This increases the risk of implant failure due to chronic cycling loads. This is rarely a problem with a properly applied dorsal plate.
  • Pressure sores from the cast or splint
 
Prognosis:
  • Prognosis for a pantarsal arthrodesis is good to excellent.
  • Overall prognosis for partial tarsal arthrodesis is excellent.
.
 For More Information: Frequently Asked Question After Surgery


Home  ·  Contact Us  ·  About Us  ·  Services  ·  Surgeries  ·  Emergencies  ·  Boarding  ·  Grooming  ·  Info  ·  Links  ·  FAQs  ·  Testimonials  ·  Disclaimer  ·  Search  ·  Site Map
Copyright © Michigan Ave Animal Hospital Ypsilanti, MI