J Korean Foot Ankle Soc.  2014 Dec;18(4):147-152. 10.14193/jkfas.2014.18.4.147.

Ankle Arthrodesis

• Lee JY
• Park SH

• KMID: 2181633
• DOI: http://doi.org/10.14193/jkfas.2014.18.4.147

Abstract

Ankle arthrodesis has been used as standard treatment of ankle arthritis unresponsive to conservative treatment. Transfibular approach was used for ankles with severe deformities and minimally invasive arthroscopic ankle arthrodesis was used for patients with mild deformities. Anterior approach may be used when lateral approach couldn't be performed. Tibiotalocalcaneal arthrodesis is standard treatment for coexisting ankle and subtalar arthritis, and modified Blair arthrodesis can be used if the talus body resection is necessary in severe talar necrosis. In serious infection of ankle arthritis, arthrodesis can be performed as staged operation. In cases with low bone density and severe deformities, Charcot arthropathy should be considered.

Keyword

Ankle; Arthrodesis

MeSH Terms

Ankle*
Arthritis
Arthrodesis*
Bone Density
Congenital Abnormalities
Humans
Necrosis
Talus

Figure

• 

  Figure 1. (A) This is a photograph of ankle arthrodesis performed with transfibular approach. (B) Home-run screw (arrow) was inserted from posterolateral aspect of tibia distally to talar head.

• 

  Figure 2. This is a photograph of ankle arthrodesis with two miniar-throtomy incisions, one just medial to tibialis anterior tendon and another just lateral to peroneus tertius tendon.

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  Figure 3. (A) This is a photograph showing the skin incision drawing for ankle arthrodesis with anterior approach. (B) Anterior longitudinal skin incision was made beginning 8 cm proximal to the ankle joint and ending distally at the medial cuneiform.

Reference

1.Raikin SM. Arthrodesis of the ankle: arthroscopic, mini-open, and open techniques. Foot Ankle Clin. 2003. 8:347–59.

2.Ahmad J., Raikin SM. Ankle arthrodesis: the simple and the complex. Foot Ankle Clin. 2008. 13:381–400.

3.Blankenhorn BD., Saltzman CL. Ankle arthritis. Coughlin MJ, Saltzman CL, Anderson RB, editors. editors.Mann’s surgery of the foot and ankle. 9th ed.Philadelphia: Saunders/Elsevier;2013. p. 1037–74.

4.Flückiger G., Weber M. The transfibular approach for ankle arthrodesis. Oper Orthop Traumatol. 2005. 17:361–79.

5.Grass R., Rammelt S., Biewener A., Zwipp H. Arthrodesis of the ankle joint. Clin Podiatr Med Surg. 2004. 21:161–78.

6.Dohm MP., Benjamin JB., Harrison J., Szivek JA. A biomechanical evaluation of three forms of internal fixation used in ankle arthrodesis. Foot Ankle Int. 1994. 15:297–300.

7.Ogilvie-Harris DJ., Fitsialos D., Hedman TP. Arthrodesis of the ankle. A comparison of two versus three screw fixation in a crossed configuration. Clin Orthop Relat Res. 1994. 304:195–9.

8.Holt ES., Hansen ST., Mayo KA., Sangeorzan BJ. Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res. 1991. 268:21–8.

9.Colman AB., Pomeroy GC. Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome. Foot Ankle Int. 2007. 28:303–7.

10.Klaue K., Bursic D. The dorsolateral approach to the ankle for arthrodesis. Oper Orthop Traumatol. 2005. 17:380–91.

11.Morgan CD., Bodenstab AB. Arthroscopic Bankart suture repair: technique and early results. Arthroscopy. 1987. 3:111–22.

12.Dannawi Z., Nawabi DH., Patel A., Leong JJ., Moore DJ. Ar-throscopic ankle arthrodesis: are results reproducible irrespective of pre-operative deformity? Foot Ankle Surg. 2011. 17:294–9.

13.Ogilvie-Harris DJ., Lieberman I., Fitsialos D. Arthroscopically assisted arthrodesis for osteoarthrotic ankles. J Bone Joint Surg Am. 1993. 75:1167–74.

14.Myerson MS., Quill G. Ankle arthrodesis. A comparison of an ar-throscopic and an open method of treatment. Clin Orthop Relat Res. 1991. 268:84–95.

15.Paremain GD., Miller SD., Myerson MS. Ankle arthrodesis: results after the miniarthrotomy technique. Foot Ankle Int. 1996. 17:247–52.

16.Miller SD., Paremain GP., Myerson MS. The miniarthrotomy technique of ankle arthrodesis: a cadaver study of operative vascular compromise and early clinical results. Orthopedics. 1996. 19:425–30.

17.Gruen GS., Mears DC. Arthrodesis of the ankle and subtalar joints. Clin Orthop Relat Res. 1991. 268:15–20.

18.Campbell CJ., Rinehart WT., Kalenak A. Arthrodesis of the ankle. Deep autogenous inlay grafts with maximum cancellous-bone apposition. J Bone Joint Surg Am. 1974. 56:63–70.

19.Kelly IP., Easley ME. Treatment of stage 3 adult acquired flatfoot. Foot Ankle Clin. 2001. 6:153–66.

20.Kelly IP., Nunley JA. Treatment of stage 4 adult acquired flatfoot. Foot Ankle Clin. 2001. 6:167–78.

21.Bohay DR., Anderson JG. Stage IV posterior tibial tendon insufficiency: the tilted ankle. Foot Ankle Clin. 2003. 8:619–36.

22.Saltzman C. Ankle arthritis. Coughlin MJ, Mann RA, Saltzman CL, editors. editors.Surgery of foot and ankle. 8th ed.Philadelphia: Mosby Elsevier;2007. p. 923–83.

23.Muir D., Angliss RD., Nattrass GR., Graham HK. Tibiotalocalca-neal arthrodesis for severe calcaneovalgus deformity in cerebral palsy. J Pediatr Orthop. 2005. 25:651–6.

24.Mulfinger GL., Trueta J. The blood supply of the talus. J Bone Joint Surg Br. 1970. 52:160–7.

25.Peterson L., Goldie I., Lindell D. The arterial supply of the talus. Acta Orthop Scand. 1974. 45:260–70.

26.Horst F., Gilbert BJ., Nunley JA. Avascular necrosis of the talus: current treatment options. Foot Ankle Clin. 2004. 9:757–73.

27.Mont MA., Schon LC., Hungerford MW., Hungerford DS. Avascular necrosis of the talus treated by core decompression. J Bone Joint Surg Br. 1996. 78:827–30.

28.Hussl H., Sailer R., Daniaux H., Pechlaner S. Revascularization of a partially necrotic talus with a vascularized bone graft from the iliac crest. Arch Orthop Trauma Surg. 1989. 108:27–9.

29.Blair H. Comminuted fractures and fracture dislocations of the body of the astragalus. Operative treatment. Am J Surg. 1943. 59:37–43.

30.Morris HD. Aseptic necrosis of the talus following injury. Or-thop Clin North Am. 1974. 5:177–89.

31.Dennis MD., Tullos HS. Blair tibiotalar arthrodesis for injuries to the talus. J Bone Joint Surg Am. 1980. 62:103–7.

32.Adelaar RS., Madrian JR. Avascular necrosis of the talus. Orthop Clin North Am. 2004. 35:383–95.

33.Baumhauer JF., Lu AP., DiGiovanni BF. Arthodesis of the infected ankle and subtalar joint. Foot Ankle Clin. 2002. 7:175–90.

34.Kollig E., Esenwein SA., Muhr G., Kutscha-Lissberg F. Fusion of the septic ankle: experience with 15 cases using hybrid external fixation. J Trauma. 2003. 55:685–91.

35.Ahmad J., Pour AE., Raikin SM. The modified use of a proximal humeral locking plate for tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2007. 28:977–83.

36.Dalla Paola L., Volpe A., Varotto D., Postorino A., Brocco E., Senesi A, et al. Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure. Foot Ankle Int. 2007. 28:967–70.

37.Caravaggi C., Cimmino M., Caruso S., Dalla Noce S. Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot. J Foot Ankle Surg. 2006. 45:20–4.

38.Myerson MS., Alvarez RG., Lam PW. Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int. 2000. 21:643–50.

39.Pinzur MS., Noonan T. Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. Foot Ankle Int. 2005. 26:545–9.

40.Hockenbury RT., Gruttadauria M., McKinney I. Use of implantable bone growth stimulation in Charcot ankle arthrodesis. Foot Ankle Int. 2007. 28:971–6.