A A narrative review of arthrodesis of the ankle joint
Keywords:
Ankle, OA, Arthrodesis, Fusion, Open surgery, ArthroscopyAbstract
Ankle arthrodesis is a common treatment used for patients with end-stage ankle osteoarthritis (OA). Approximately 80% of ankle OA is post-traumatic. Clinical examination and weightbearing radiographs are sufficient to asses ankle OA. Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms. After the failure of conservative medical treatment, surgical intervention can be considered. There are many variations in operative technique including different approaches (open or arthroscopic) and various fixation methods. Each technique has its advantages and disadvantages. The surgical goal of arthrodesis is to align the tibiotalar joint in slightly valgus (0°-5°), neutral dorsiflexion and slightly external rotation (5º-10º). In our review article we described the indications and goals of arthrodesis for treatment of end-stage ankle OA. A systematic step by step operative technique guide is described for the arthroscopic, open anterior and open lateral approaches including a postoperative protocol and possible complications.
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References
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8. MichelsonJ,EasleyM,Wigley FM, et al.Foot and ankle problems in rheumatoid OA. Foot Ankle Int 1994;15(11):608–13.
9. Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle OA:report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 2005;25:44–6.
10. Žlak T, Žlak N, Drobnič M. Patient-reported joint status, quality of life, and activity level with the end-stage hindfoot and ankle OA. ActaOrthopaedica et traumatologicahellenica2023;64(1): 10-19
11. Mann RA, Rongstad KM. Arthrodesis of the ankle: a critical analysis.Foot Ankle Int 1998;19:3–9.
12. Scranton PE. An overview of ankle arthrodesis. ClinOrthop 1991;268:96–101.
13. Katcherian DA. Treatment of ankle arthrosis. ClinOrthop 1998;349:48–57.
14. Morgan CD, Henke JA, Bailey RW, et al. Long-term results of tibiotalar arthrodesis. J Bone Joint Surg Am 1985;67(4):546–50.
15. Takakura Y, Tanaka Y, Sugimoto K, et al. Long-term results of arthrodesis for OA of the ankle. ClinOrthopRelat Res 1999;(361):178–85.
16. Kitaoka HB, RomnessDW. Arthrodesis for failed ankle arthroplasty. J Arthroplasty 1992;7(3):277–84.
17. Klouche S, El-Masri F, Graff W, et al. Arthrodesis with internal fixation of theinfected ankle. J Foot Ankle Surg 2011;50(1):25–30.
18. Casadei R, Ruggieri P, Giuseppe T, et al. Ankle resection arthrodesis in patientswith bone tumors. Foot Ankle Int 1994;15(5):242–9.
19. Ayoub MA. Ankle fractures in diabetic neuropathic arthropathy: can tibiotalararthrodesis salvage the limb? J Bone Joint Surg Br 2008;90(7):906–14.
20. Nihal A, Gellman RE, Embil JM, et al. Ankle arthrodesis. Foot Ankle Surg 2008; 14(1):1–10.
21. Hirsch AT, HaskalZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for themanagement of patients with peripheral arterial disease (lower extremity, renal,mesenteric, and abdominal aortic): a collaborative report from the AmericanAssociation for Vascular Surgery/Society for Vascular Surgery, Society for CardiovascularAngiography and Interventions, Society for Vascular Medicine andBiology, Society of Interventional Radiology, and the ACC/AHA Task Force onPractice Guidelines (Writing Committee to Develop Guidelines for the Managementof Patients With Peripheral Arterial Disease): endorsed by the AmericanAssociation of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung,and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus;and Vascular Disease Foundation. Circulation 2006;113(11):e463–654.
22. Greenhagen RM, Johnson AR, Bevilacqua NJ. Smoking cessation: the role of the foot and ankle surgeon. Foot Ankle Spec 2010;3(1):21–8.
23. McGlamry ED, Banks AS. McGlamry’s comprehensive textbook of foot and ankle surgery. Philadelphia: Lippincott Williams & Wilkins; 2001
24. Thomas RH, Daniels TR. Ankle OA. J Bone Joint Surg Am 2003;85(5):923–36.
25. Leffler S, Disler DG. MR imaging of tendon, ligament, and osseous abnormalities of the ankle and hindfoot. RadiolClin North Am 2002;40(5):1147–70.
26. Winson IG, Robinson DE, Allen PE. Arthroscopic ankle arthrodesis. J Bone Joint Surg Br 2005; 87: 343-347 [PMID: 15773643 DOI: 10.1302/0301-620X.87B3.15756]
27. Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, NalysnykL. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am 2007; 89: 1899-1905 [PMID: 17768184 DOI: 10.2106/JBJS.F.01149]
28. Daniels TR, Younger AS, Penner M, Wing K, Dryden PJ, Wong H, Glazebrook M. Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study. J Bone Joint Surg Am 2014; 96: 135-142 [PMID: 24430413 DOI: 10.2106/JBJS. L.01597]
29. Krause FG, Windolf M, Bora B, Penner MJ, Wing KJ, Younger AS. Impact of complications in total ankle replacement and ankle arthrodesis analyzed with a validated outcome measurement. J Bone Joint Surg Am 2011; 93: 830-839 [PMID: 21498491 DOI: 10.2106/JBJS.J.00103]
30. Jordan RW, ChahalGS, Chapman A. Is end-stage ankle arthrosis best managed with total ankle replacement or arthrodesis? A systematic review. AdvOrthop2014; 2014: 986285 [PMID: 25215242 DOI: 10.1155/2014/986285]
31. SooHoo NF, Zingmond DS, Ko CY. Comparison of reoperationrates following ankle arthrodesis and total ankle arthroplasty. JBone Joint Surg Am 2007; 89: 2143-2149 [PMID: 17908889 DOI:10.2106/JBJS.F.01611]
32. Perlman MH, Thordarson DB. Ankle fusion in a high risk population: an assessment of nonunion risk factors. Foot Ankle Int 1999;20(8):491–6.
33. Takenouchi K, Morishita M, Saitoh K, et al. Long-term results of ankle arthrodesis using an intramedullary nail with fins in patients with rheumatoid OA hindfoot deformity. J Nippon Med Sch 2009;76(5):240–6.
34. Scranton PE Jr. Use of internal compression in arthrodesis of the ankle. J Bone Joint Surg Am 1985;67(4):550–5.
35. BudnarVM, Hepple S, Harries WG, et al. Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail. Foot Ankle Int 2010;31(12):1085–92.
36. Boer R, Mader K, Pennig D, et al. Tibiotalocalcaneal arthrodesis using a reamed retrograde locking nail. ClinOrthopRelat Res 2007;463:151–6.
37. Chalayon O, Wang B, Blankenhorn B, et al. Factors affecting the outcomes of uncomplicated primary open ankle arthrodesis. Foot Ankle Int 2015;36(10):1170–9.
38. Lee H-J, Min W-K, Kim J-S, et al. Transfibular ankle arthrodesis using burring, curettage, multiple drilling and fixation with two retrograde screws through a single lateral incision. J OrthopSurg 2016;24(1):101–5.
39. Akra GA, Middleton A, Adedapo AO, et al. Outcome of ankle arthrodesis using a transfibular approach. J Foot Ankle Surg 2010;49(6):508–12.
40. Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg Am 1979;61(7):964–75.
41. Abdo RV, Wasilewski SA. Ankle arthrodesis: a long-term study. Foot Ankle 1992; 13(6):307–12.
42. Coester LM, Saltzman CL, Leupold J, et al. Long-term results following ankle arthrodesis for post-traumatic OA. J Bone Joint Surg Am 2001;83(2):219–28.
43. Jackson A, Glasgow M. Tarsal hypermobility after ankle fusion–fact or fiction? J Bone Joint Surg Br 1979;61(4):470–3.
44. Howell WR, Goulston C. Osteomyelitis: an update for hospitalists. HospPract (Minneap) 2011;39(1):153–60.
45. Muir DC, Amendola A, Saltzman CL. Long-term outcome of ankle arthrodesis. Foot Ankle Clin N Am 7 (2002) 703–708
2. Herrera-Pérez M, González-Martín D, Vallejo-Márquez M, Godoy-Santos AL, Valderrabano V, Tejero S. Ankle OAaetiology. Journal of Clinical Medicine 202110 4489. ( 10.3390/jcm10194489) [PMC free article] [PubMed] [CrossRef] [Google Scholar]
3. Harrington KD.DegenerativeOA of the ankle secondary to long-standing lateral ligament instability. Journal of Bone and Joint Surgery: American Volume 197961354–361. ( 10.2106/00004623-197961030-00006)
4. Saltzman CL, el-Khoury GY. The hindfoot align¬ment view. Foot Ankle Int. 1995 Sep;16(9):572-6. doi: 10.1177/107110079501600911. PMID: 8563927.
5. Saltzman CL, Nawoczenski DA, Talbot KD. Meas¬urement of the medial longitudinal arch. Arch Phys Med Rehabil. 1995 Jan;76(1):45-9. doi: 10.1016/s0003- 9993(95)80041-7. PMID: 7811174.
6. Barg A, Pagenstert GI, Hügle T, Gloyer M, Wiewiorski M, Henninger HB, Valderrabano V. Ankle OA: etiology, diagnostics, and classification. Foot Ankle Clin. 2013 Sep;18(3):411-26. doi: 10.1016/j.fcl.2013.06.001. Epub 2013 Jul 24. PMID: 24008208
7. Holzer N, Salvo D, Marijnissen ACA, Vincken KL, Ahmad AC, Serra E, et al. Radiographic evaluation of posttraumatic OA of the ankle: the Kellgren- Lawrence scale is reliable and correlates with clinical symptoms. OA Cartilage 2015;23(3):363–9.
8. MichelsonJ,EasleyM,Wigley FM, et al.Foot and ankle problems in rheumatoid OA. Foot Ankle Int 1994;15(11):608–13.
9. Saltzman CL, Salamon ML, Blanchard GM, et al. Epidemiology of ankle OA:report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 2005;25:44–6.
10. Žlak T, Žlak N, Drobnič M. Patient-reported joint status, quality of life, and activity level with the end-stage hindfoot and ankle OA. ActaOrthopaedica et traumatologicahellenica2023;64(1): 10-19
11. Mann RA, Rongstad KM. Arthrodesis of the ankle: a critical analysis.Foot Ankle Int 1998;19:3–9.
12. Scranton PE. An overview of ankle arthrodesis. ClinOrthop 1991;268:96–101.
13. Katcherian DA. Treatment of ankle arthrosis. ClinOrthop 1998;349:48–57.
14. Morgan CD, Henke JA, Bailey RW, et al. Long-term results of tibiotalar arthrodesis. J Bone Joint Surg Am 1985;67(4):546–50.
15. Takakura Y, Tanaka Y, Sugimoto K, et al. Long-term results of arthrodesis for OA of the ankle. ClinOrthopRelat Res 1999;(361):178–85.
16. Kitaoka HB, RomnessDW. Arthrodesis for failed ankle arthroplasty. J Arthroplasty 1992;7(3):277–84.
17. Klouche S, El-Masri F, Graff W, et al. Arthrodesis with internal fixation of theinfected ankle. J Foot Ankle Surg 2011;50(1):25–30.
18. Casadei R, Ruggieri P, Giuseppe T, et al. Ankle resection arthrodesis in patientswith bone tumors. Foot Ankle Int 1994;15(5):242–9.
19. Ayoub MA. Ankle fractures in diabetic neuropathic arthropathy: can tibiotalararthrodesis salvage the limb? J Bone Joint Surg Br 2008;90(7):906–14.
20. Nihal A, Gellman RE, Embil JM, et al. Ankle arthrodesis. Foot Ankle Surg 2008; 14(1):1–10.
21. Hirsch AT, HaskalZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for themanagement of patients with peripheral arterial disease (lower extremity, renal,mesenteric, and abdominal aortic): a collaborative report from the AmericanAssociation for Vascular Surgery/Society for Vascular Surgery, Society for CardiovascularAngiography and Interventions, Society for Vascular Medicine andBiology, Society of Interventional Radiology, and the ACC/AHA Task Force onPractice Guidelines (Writing Committee to Develop Guidelines for the Managementof Patients With Peripheral Arterial Disease): endorsed by the AmericanAssociation of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung,and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus;and Vascular Disease Foundation. Circulation 2006;113(11):e463–654.
22. Greenhagen RM, Johnson AR, Bevilacqua NJ. Smoking cessation: the role of the foot and ankle surgeon. Foot Ankle Spec 2010;3(1):21–8.
23. McGlamry ED, Banks AS. McGlamry’s comprehensive textbook of foot and ankle surgery. Philadelphia: Lippincott Williams & Wilkins; 2001
24. Thomas RH, Daniels TR. Ankle OA. J Bone Joint Surg Am 2003;85(5):923–36.
25. Leffler S, Disler DG. MR imaging of tendon, ligament, and osseous abnormalities of the ankle and hindfoot. RadiolClin North Am 2002;40(5):1147–70.
26. Winson IG, Robinson DE, Allen PE. Arthroscopic ankle arthrodesis. J Bone Joint Surg Br 2005; 87: 343-347 [PMID: 15773643 DOI: 10.1302/0301-620X.87B3.15756]
27. Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, NalysnykL. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am 2007; 89: 1899-1905 [PMID: 17768184 DOI: 10.2106/JBJS.F.01149]
28. Daniels TR, Younger AS, Penner M, Wing K, Dryden PJ, Wong H, Glazebrook M. Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study. J Bone Joint Surg Am 2014; 96: 135-142 [PMID: 24430413 DOI: 10.2106/JBJS. L.01597]
29. Krause FG, Windolf M, Bora B, Penner MJ, Wing KJ, Younger AS. Impact of complications in total ankle replacement and ankle arthrodesis analyzed with a validated outcome measurement. J Bone Joint Surg Am 2011; 93: 830-839 [PMID: 21498491 DOI: 10.2106/JBJS.J.00103]
30. Jordan RW, ChahalGS, Chapman A. Is end-stage ankle arthrosis best managed with total ankle replacement or arthrodesis? A systematic review. AdvOrthop2014; 2014: 986285 [PMID: 25215242 DOI: 10.1155/2014/986285]
31. SooHoo NF, Zingmond DS, Ko CY. Comparison of reoperationrates following ankle arthrodesis and total ankle arthroplasty. JBone Joint Surg Am 2007; 89: 2143-2149 [PMID: 17908889 DOI:10.2106/JBJS.F.01611]
32. Perlman MH, Thordarson DB. Ankle fusion in a high risk population: an assessment of nonunion risk factors. Foot Ankle Int 1999;20(8):491–6.
33. Takenouchi K, Morishita M, Saitoh K, et al. Long-term results of ankle arthrodesis using an intramedullary nail with fins in patients with rheumatoid OA hindfoot deformity. J Nippon Med Sch 2009;76(5):240–6.
34. Scranton PE Jr. Use of internal compression in arthrodesis of the ankle. J Bone Joint Surg Am 1985;67(4):550–5.
35. BudnarVM, Hepple S, Harries WG, et al. Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail. Foot Ankle Int 2010;31(12):1085–92.
36. Boer R, Mader K, Pennig D, et al. Tibiotalocalcaneal arthrodesis using a reamed retrograde locking nail. ClinOrthopRelat Res 2007;463:151–6.
37. Chalayon O, Wang B, Blankenhorn B, et al. Factors affecting the outcomes of uncomplicated primary open ankle arthrodesis. Foot Ankle Int 2015;36(10):1170–9.
38. Lee H-J, Min W-K, Kim J-S, et al. Transfibular ankle arthrodesis using burring, curettage, multiple drilling and fixation with two retrograde screws through a single lateral incision. J OrthopSurg 2016;24(1):101–5.
39. Akra GA, Middleton A, Adedapo AO, et al. Outcome of ankle arthrodesis using a transfibular approach. J Foot Ankle Surg 2010;49(6):508–12.
40. Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg Am 1979;61(7):964–75.
41. Abdo RV, Wasilewski SA. Ankle arthrodesis: a long-term study. Foot Ankle 1992; 13(6):307–12.
42. Coester LM, Saltzman CL, Leupold J, et al. Long-term results following ankle arthrodesis for post-traumatic OA. J Bone Joint Surg Am 2001;83(2):219–28.
43. Jackson A, Glasgow M. Tarsal hypermobility after ankle fusion–fact or fiction? J Bone Joint Surg Br 1979;61(4):470–3.
44. Howell WR, Goulston C. Osteomyelitis: an update for hospitalists. HospPract (Minneap) 2011;39(1):153–60.
45. Muir DC, Amendola A, Saltzman CL. Long-term outcome of ankle arthrodesis. Foot Ankle Clin N Am 7 (2002) 703–708
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