J Korean Foot Ankle Soc.  2014 Dec;18(4):183-188. 10.14193/jkfas.2014.18.4.183.

Early Weight Bearing Ambulation after Arthroscopic Ankle Arthrodesis

• Kim YC
• Cho SW
• Chung JW

• KMID: 2181639
• DOI: http://doi.org/10.14193/jkfas.2014.18.4.183

Abstract

PURPOSE
The accepted general management principle after ankle arthrodesis is to maintain non-weight bearing for 6 to 8 weeks. The aim of this study was to report clinical outcome of patients allowed early weight bearing after arthroscopic arthrodesis.
MATERIALS AND METHODS
We analyzed medical records and radiographs to determine fusion rate and complication risk of 22 sequential patients allowed to walk under short leg cast within 3 days after arthroscopic ankle arthrodesis using 2 screws from January 2008 to June 2012. The minimum follow-up period was 18 months, and the mean age of the patients was 67 years.
RESULTS
The mean visual analog scale was decreased from 8.9 points preoperatively to 2.3 points after 12 months. Complete ankle fusion was achieved in 19 patients (86.4%) at 3-month follow-up. There were 2 cases of delayed union and one case of nonunion at 12-month follow-up. There was no other complication such as wound problem, persistent swelling of the ankle.
CONCLUSION
Bony union may not be interfered even though patients were allowed to walk under cast within a few days after arthroscopic ankle arthrodesis.

Keyword

Ankle; Arthroscopy; Arthrodesis; Early weight bearing

MeSH Terms

Ankle*
Arthrodesis*
Arthroscopy
Follow-Up Studies
Humans
Leg
Medical Records
Visual Analog Scale
Walking*
Weight-Bearing*
Wounds and Injuries

Figure

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  Figure 1. The preoperative anteroposterior (A) and lateral (B) radiographs of 68-year-old male patient showed severe osteoarthritis of the left ankle. (C, D) This patient was allowed to bear weight in a short leg walking cast on postoperative day. (E, F) Postoperative radiographs at 3 months demonstrated solid fusion of the joint.

• 

  Figure 2. The preoperative (A) and immediate postoperative (B) lateral radiograph of 63-year-old female patient showed the gap was formed all over the joint after the surgery. (C) The postoperative radiograph at 16 weeks demonstrated incomplete fusion at the posterior joint.

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  Figure 3. The single case of nonunion in our study. The preoperative (A) and immediate postoperative (B) lateral radiograph of 71-year-old female patient showed large gap was formed at the anterior joint after screw fixation. (C) At six weeks the screw was migrated and the size of the anterior gap was decreased after weight bearing ambulation. (D) The postoperative radiograph at 12 months demonstrated fibrous nonunion of the joint after reinsertion of the screw.

Reference

1.Boc SF., Norem ND. Ankle arthrodesis. Clin Podiatr Med Surg. 2012. 29:103–13.

2.DeHeer PA., Catoire SM., Taulman J., Borer B. Ankle arthrodesis: a literature review. Clin Podiatr Med Surg. 2012. 29:509–27.

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

4.Kwon DG., Chung CY., Park MS., Sung KH., Kim TW., Lee KM. Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model. Int Orthop. 2011. 35:1647–53.

5.Flavin R., Coleman SC., Tenenbaum S., Brodsky JW. Comparison of gait after total ankle arthroplasty and ankle arthrodesis. Foot Ankle Int. 2013. 34:1340–8.

6.Gougoulias NE., Agathangelidis FG., Parsons SW. Arthroscopic ankle arthrodesis. Foot Ankle Int. 2007. 28:695–706.

7.Lee MS. Arthroscopic ankle arthrodesis. Clin Podiatr Med Surg. 2011. 28:511–21.

8.Townshend D., Di Silvestro M., Krause F., Penner M., Younger A., Glazebrook M, et al. Arthroscopic versus open ankle arthrodesis: a multicenter comparative case series. J Bone Joint Surg Am. 2013. 95:98–102.

9.Peterson KS., Lee MS., Buddecke DE. Arthroscopic versus open ankle arthrodesis: a retrospective cost analysis. J Foot Ankle Surg. 2010. 49:242–7.

10.Strasser NL., Turner NS. Functional outcomes after ankle arthrodesis in elderly patients. Foot Ankle Int. 2012. 33:699–703.

11.Charnley J. Compression arthrodesis of the ankle and shoulder. J Bone Joint Surg Br. 1951. 33B:180–91.

12.Pugely AJ., Lu X., Amendola A., Callaghan JJ., Martin CT., Cram P. Trends in the use of total ankle replacement and ankle arthrodesis in the United States Medicare population. Foot Ankle Int. 2014. 35:207–15.

13.O’Brien TS., Hart TS., Shereff MJ., Stone J., Johnson J. Open versus arthroscopic ankle arthrodesis: a comparative study. Foot Ankle Int. 1999. 20:368–74.

14.Ahlberg A., Henricson AS. Late results of ankle fusion. Acta Or-thop Scand. 1981. 52:103–5.

15.Frey C., Halikus NM., Vu-Rose T., Ebramzadeh E. A review of ankle arthrodesis: predisposing factors to nonunion. Foot Ankle Int. 1994. 15:581–4.

16.Collman DR., Kaas MH., Schuberth JM. Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients. Foot Ankle Int. 2006. 27:1079–85.

17.Starkweather MP., Collman DR., Schuberth JM. Early protected weightbearing after open reduction internal fixation of ankle fractures. J Foot Ankle Surg. 2012. 51:575–8.

18.Blitz NM., Lee T., Williams K., Barkan H., DiDimenico LA. Early weight bearing after modified lapidus arthodesis: a multicenter review of 80 cases. J Foot Ankle Surg. 2010. 49:357–62.

19.Wagner E., Ortiz C., Villalón IE., Keller A., Wagner P. Early weightbearing after percutaneous reduction and screw fixation for low-energy lisfranc injury. Foot Ankle Int. 2013. 34:978–83.

20.Dayton P., McCall A. Early weightbearing after first metatarsophalangeal joint arthrodesis: a retrospective observational case analysis. J Foot Ankle Surg. 2004. 43:156–9.

21.Blitz NM. Early weightbearing of the Lapidus bunionectomy: is it feasible? Clin Podiatr Med Surg. 2012. 29:367–81.

22.Mah CD., Banks AS. Immediate weight bearing following first metatarsophalangeal joint fusion with Kirschner wire fixation. J Foot Ankle Surg. 2009. 48:3–8.