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About Orthopedic Specialists

Orthopedic Specialists of Seattle provides new and advanced procedures including endoscopic carpel tunnel release surgery for carpal tunnel syrome, complex joint restoration procedures, anterior approach hip replacement surgery, and more.

Knee Arthritis

What Is Arthritis of the Knee?

The word “arthritis” basically means “inflammation of the joint”. Inflammation is the body’s natural reaction to injury or disease. With inflammation, the area involved develops stiffness, pain, and swelling and it can last for a long time or recur, leading to tissue damage.

A joint is where two bones join together. The knee is the largest joint of the body. The bones of a joint are covered with a spongy material called cartilage to allow a cushion for the bones so the joint can move without pain. With arthritis, the area in and around the joint becomes inflamed and the cartilage cushion may be damaged, making mobility difficult.

Is There More than One Type of Arthritis?

There are more than one-hundred types of arthritis but the most common type is osteoarthritis. Two other common types include rheumatoid arthritis and gouty arthritis.

Osteoarthritis: Osteoarthritis occurs when the cartilage covering the bone ends gradually wears away, thus earning it the name “wear-and-tear arthritis.” When the cartilage is damaged, the bones begin to rub against each other leading to swelling and pain. Osteoarthritis can occur in any of the joints in the body, but it affects the knee most commonly.

Rheumatoid Arthritis: Also called RA, Rheumatoid arthritis is a long-lasting disease that leads to deformities and destruction of the joints. It most commonly involves the knees, wrists, and hands. With rheumatoid arthritis, the body’s immune system mistakenly attacks itself causing the joint lining to swell and ache. The inflammation associated with RA spreads to the surrounding tissues and will eventually damage bone and cartilage. This leads to an unstable joint, pain with movement, and profound stiffness.

Gouty Arthritis: Gout is a painful condition of the joints where the body cannot eliminate uric acid or produces too much uric acid. This natural substance builds up and forms needle-like crystals in the joint leading to severe pain and swelling. Gouty arthritis most often affects the big toe, but can involve other joints including the knee and the wrist joints.

What Are the Symptoms of Arthritis?

The various kinds of arthritis produce different symptoms and it really depends on the severity from person-to-person. The most common symptoms are swelling, pain, stiffness, tenderness, warmth of the joint, and redness.

How Is Arthritis Diagnosed?

Most forms of arthritis are diagnosed with a complete medical history and various imaging techniques. Your orthopedic specialist will take X-rays or MRIs to evaluate the condition of your joints. Sometimes it is necessary for your doctor to do tests on your blood, urine, and joint fluid to determine the type of arthritis you have.

How is Knee Arthritis Treated?

Your orthopedic specialist cares about your health so the goal of treatment is to provide pain relief for you and to increase your mobility and strength in the knee joint. Treatment options include exercises, medications, heat compresses, cold therapy, or knee surgery.

What is Involved in Surgical Treatment?

If your arthritis does not respond to the nonsurgical therapies your orthopedic specialist tries, you may benefit from surgery. There are many surgical options available. The first is knee arthroscopy where the orthopedic surgeon uses fiber optic technology to view inside the joint, repair what is damaged, and perform necessary surgical techniques.

Another procedure is an osteotomy that cuts the shinbone or the thighbone to improve the alignment of the joint. Sometimes it is necessary for the doctor to do a total or partial knee arthroplasty to replace the severely damaged knee joint cartilage with plastic and metal prostheses. Finally, there is cartilage grafting that is done when the knee has limited cartilage or loss of cartilage.

Meet Our Knee Surgery Specialists

Learn More about Dr. Grant H. Garcia, MD

Learn More about Dr. Charlie Peterson, MD

What is triple arthrodesis?

Arthrodesis

Arthrodesis is a medical term that describes fusion. In a fusion, the bones are locked together by removing the cartilage from the joint surface and creating a “bone bridge” across the joint. A triple arthrodesis is a fusion in the hindfoot (back of the foot) used to treat many types of painful foot deformities. This procedure fuses the joints under the ankle that allow the foot to move from side to side. These joints are the talonavicular, subtalar, and calcaneocuboid.

Surgeons try to avoid fusions, but sometimes pain and deformity are so severe that this procedure offers the best chance of producing a less painful foot with better alignment. Fusions often improve stability and allow for easier standing and walking. The hindfoot fusion is a time-tested, durable procedure.

Three joints in the back of the foot

Triple arthrodesis fuses three joints in the back of the foot: the talonavicular (blue arrow), subtalar (red arrow), and calcaneocuboid (green arrow)

Diagnosis

A hindfoot fusion is indicated for severe arthritis, instability, or a deformity that cannot be controlled with non-surgical treatments. Other conditions, such as severe flatfoot, abnormal connections between bones, excessively high arches, and joint instability due to neuromuscular disease, also can indicate the need for a fusion.

Patients who are still growing are not ideal candidates as they may develop additional deformity as they grow. Patients who use tobacco, have an active infection, or have poor healing potential are at higher risk for complications. Non-surgical measures such as bracing and anti-inflammatory medications should be tried first. If another surgical procedure that leaves the joint intact can achieve the same goal, that procedure is preferred over a fusion.

Treatment

In a triple arthrodesis, your foot and ankle orthopedic surgeon makes one incision on each side of the foot, and works in each joint, removing cartilage, roughening bony surfaces, and filling defects. Once all the desired joints have been prepared, they are put into an appropriate position and hardware is placed to stabilize the reconstruction and promote healthy fusion.

Recovery

The rate of healing is variable and is influenced by many factors. In general, the foot is placed into a splint and kept elevated with no weight on it for the first two weeks to minimize swelling and allow for healing of the skin. Stitches may be removed 2-3 weeks after surgery.

Different weight-bearing protocols may be used. After signs of healing are noted, progressive weight bearing is allowed until full weight bearing is reached. This typically takes three months. During this process, the foot may be placed into a cast. Sometimes, a removable boot may be used rather than a cast.

Risks and Complications

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Most patients are satisfied with their outcome once they achieve successful fusion. In fact, most feel that the loss of motion is a very acceptable trade-off for pain reduction. In the first two to three weeks, the most likely complication is wound breakdown and/or infection. These are best avoided by not smoking, elevating the foot, avoiding any weight on the foot, and keeping the surgical dressing clean and dry. There also is the risk of the bones not fusing (a non-union). Smoking may place you at increased risk for non-union.

The most common long-term consequence of triple arthrodesis is gradual development of arthritis in other joints of the foot and ankle. These changes can take years or even decades to develop and many never become noticeable to the patient.

FAQs

Will I have stiffness after surgery?

Yes, you can expect some degree of stiffness in your foot as a result of the surgery. You will maintain up-and-down motion, but side-to-side motion will become limited. This will be most noticeable on uneven surfaces but is usually a good trade-off for reasonable pain relief, improved stability and/or deformity correction. Many patients who undergo this surgery have a stiff, painful foot to begin with; after surgery the stiffness may remain but the pain will be relieved.

Will I be able to return to my usual activities?

You can generally expect to return to most activities in life, but the stiffness in side-to-side motion will limit certain activities requiring this motion.

When can I expect to have recovered from a triple arthrodesis?

A significant amount of healing will occur in the first three months. However, it takes about one year for maximum improvement.

Are there side effects to triple arthrodesis?

As one part of the foot is made stiffer, other structures are forced to accept more stress, which increases the chances that they may wear out. This often takes many years or decades to become noticeable.

Will I be able to fit into regular shoes?

Typically patients fit into a shoe after surgery better than before surgery.

When will I be able to bear weight on my foot?

Partial weight bearing typically is allowed once incisions have healed. Full weight bearing generally takes between 2 and 4 months.