Open Ankle Arthrodesis: A Retrospective Analysis Comparing Different Fixation Methods

A wide variation of surgical options, complications, and union rates are reported in the treatment of end-stage ankle arthritis. However, open ankle arthrodesis remains the golden standard for ankle arthritis. The purpose of this study was to evaluate the union rate and complication rate as well as identify potential risk factors for different methods of fixation in patients with end-stage ankle arthritis of different etiology. In total, 42 ankles of 41 patients with ankle osteoarthritis were included for this single-center retrospective study. The mean age was 50 years (range 22-75 years). Twenty patients were treated with screw-fixation, 14 with plate(s) and 8 with intramedullary nail. The results of this study showed an overall union rate of 97.6% (41 of the 42 operated ankles) and an overall complication rate of 21.4% (9 events). The mean follow-up time was 16 months (range 2.5-83.0 months). Complications consisted of 1 nonunion, 4 deep infections, 2 cases of wound dehiscence, 1 delayed union and 1 malalignment of the ankle joint. The plate-fixation group demonstrated significantly higher infections when compared with screw and intramedullary nail fixation (p = .017). There were no other significant variables for incidence of complications between patients in the uncomplicated and complicated group. This study achieved good clinical results for different methods of fixation in open ankle arthrodesis. In specific, the use of intramedullary nail provides excellent results for end-stage ankle arthritis with high union rate and a low complication rate.     

Arthroscopic Ankle Arthrodesis with Intra-articular Distraction

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient’s position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction.     

Arthroscopic Ankle Arthrodesis for End-Stage Tuberculosis of the Ankle: A 2-Year Follow-Up

Surgical treatment for end-stage ankle joint tuberculosis (TB) has rarely been reported. This study followed cases treated by arthroscopic arthrodesis for ankle joint TB to evaluate its efficacy and safety in the clinic. Patients who underwent arthroscopic ankle arthrodesis for ankle joint TB between April 11, 2010, and December 31, 2016, were followed. Their diagnoses were confirmed by bacterial culture or pathological examination. During arthroscopy, tissue samples were first obtained to further confirm the diagnosis. Then the necrotic tissue, hyperplasia of synovial tissue, and exfoliated cartilage were removed. Ankle joint arthrodesis was performed if the area of articular cartilage damage was >2 cm². Continued nutritional support and standardized anti-TB drug treatment were given after surgery. Follow-up measurements included visual analogue scale score, American Orthopaedic Foot and Ankle Society score, erythrocyte sedimentation rate, and radiographic imaging. All 9 patients in this study, with an average age of 54 (range 37 to 68) years, were followed. The mean follow-up duration was 55.44 ± 31.15 (range 24 to 96) months. There were significant differences in the visual analogue scale scores, American Orthopaedic Foot and Ankle Society scores, and erythrocyte sedimentation rate between before treatment and 18 months postoperatively (p < .05). All patients (100%) showed union at 18 ± 4 weeks. Arthroscopic treatment for ankle joint TB has the advantages of minor trauma and low complications. It can be used to accurately obtain samples from specific areas of TB for further diagnosis. According to the degree of articular cartilage damage, the surgeon can determine whether to perform arthrodesis. Thorough debridement of necrotic tissue and residual articular cartilage on the fusion surface can improve the rate of ankle fusion.     

A Retrospective Analysis Evaluating Allogeneic Cancellous Bone Sponge for Foot and Ankle Arthrodesis

The present retrospective case crossover study was conducted to determine the effectiveness and safety data associated with the use of an allogeneic, cancellous bone sponge in an orthopedic foot and ankle population. We reviewed the medical records of 47 subjects (80 joints) who had undergone foot and/or ankle fusion with the cancellous bone sponge. The records were reviewed up to 12 months postoperatively. The joints included in the present study were 12 ankles, 3 ankle syndesmotic fusions (with concurrent total ankle arthroplasty), 17 subtalar joints, 17 talonavicular joints, 9 calcaneocubiod joints, 1 naviculocuneiform joint, 13 first tarsometatarsal joints, 6 lesser tarsometatarsal joints, and 2 first metatarsophalangeal joints. The endpoints of the present study were solid, sustained foot and ankle fusion, as demonstrated radiographically, and the occurrence of unexpected adverse effects related to the graft. The fusion rates were compared with those reported in other studies. The patient-reported outcome variables for the present study included the visual analog pain scale and the American Orthopaedic Foot and Ankle Score. The use of a cancellous sponge showed statistically significant improvements in pain and function and comparable or better fusion rates compared with outcomes reported in other published reports.     

Primary Ankle Arthrodesis for Neglected Open Weber B Ankle Fracture Dislocation

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.     

Ankle Arthrodesis: A Retrospective Analysis Comparing Single Column,Locked Anterior Plating to Crossed Lag Screw Technique

Ankle arthrodesis is performed to eliminate pain due to end-stage osteoarthritis, regardless of etiology. This procedure remains the reference standard treatment for end-stage ankle arthritis, despite recent advancements in total ankle replacement. The objective of the present study was to retrospectively evaluate the radiographic and clinical fusion rates and time to bony fusion for patients who underwent ankle arthrodesis using an anterior approach with a single column locked plate construct versus crossed lag screws. We identified 358 patients who had undergone ankle arthrodesis from January 2003 to June 2013. Of the 358 patients, 83 (23.2%) met the inclusion criteria for the present study. Of the 83 included patients, 47 received locked anterior (or anterolateral) plate fixation, and 36 received crossed lag screw constructs. The overall nonunion rate was 6.0% (n = 5), with 1 nonunion in the anterior plate group (2.1%) and 4 nonunions in the crossed lag screw group (11.1%; p = .217). No differences were identified between the 2 groups for normal talocrural angle [χ² (1) = 0.527; p = .468], normal tibial axis/talar ratio [χ² (1) = 0.004; p = .952], and lateral dorsiflexion angle (p = .565). Based on our findings in similar demographic groups, ankle arthrodesis using locked anterior plate fixation is a safe technique with similar complication rates and radiographic outcomes to those of crossed lag screws.     

A Survey for End-Stage Ankle Arthritis Treatment: Ankle Arthrodesis Versus Ankle Arthroplasty

With promising technological advances, ankle arthroplasty has become an alternative to arthrodesis, traditionally the gold standard, for treating end-stage ankle arthritis. We collected knowledge and perceptions on both procedures to determine the need for a patient decision aid for these patients by administering a cross-sectional survey to 103 orthopaedic surgeons. Respondents were predominantly male and 41 to 50 years old. Half of those who stated that they do not perform arthroplasty said this was because they do not have adequate training. Additionally, certain variables were associated with the surgeon's choice of intervention: patient gender, age, body mass index, postoperative activity level, employment type, perceived risk of infection, neurovascular injury or wound complication, risk of developing or pre-existing adjacent arthritis, deformity, malalignment, bone loss or abnormal bone quality, number of prior ankle operations, cause of arthritis, and desire for motion preservation. The majority agreed that they always incorporate patient preferences into their decisions and that a decision aid would be beneficial. This survey revealed that several patient characteristics are influential in the surgeon's preference for either arthroplasty or arthrodesis for end-stage ankle arthritis. Because the majority of surgeons incorporate patient preferences in their decisions and report that a decision aid would be beneficial for informed decision-making in this clinical scenario, this survey identified an unmet need supporting the development of such a tool for these patients.