Clin Orthop Surg.  2018 Sep;10(3):368-373. 10.4055/cios.2018.10.3.368.

Ankle Arthrodesis: A Comparison of Anterior Approach and Transfibular Approach

• Kim JG
• Ha DJ
• Gwak HC
• Kim CW
• Kim JH
• Lee SJ
• Kim YJ
• Lee CR
• Park JH

• KMID: 2418758
• DOI: http://doi.org/10.4055/cios.2018.10.3.368

Abstract

BACKGROUND
The purpose of this study was to compare clinical and radiological results of arthrodesis performed by the anterior approach and by the transfibular approach in ankle osteoarthritis.
METHODS
Sixty patients underwent open arthrodesis (38 by the anterior approach and 22 by the transfibular approach). The visual analogue scale score and the American Orthopedic Foot and Ankle Society (AOFAS) score were examined clinically, and radiological examination was performed on the alignment of the lower extremity and bone union.
RESULTS
Both groups showed significant improvement in AOFAS score (from 39.8 to 58.3 in the anterior approach group and from 44.5 to 60.7 in the transfibular approach group). There was no significant difference in AOFAS score at the last follow-up in both groups. The time to fusion was 13.5 weeks in the anterior approach group and 11.8 weeks in the transfibular approach group. Nonunion occurred in four cases in the anterior approach group and in one case in the transfibular approach group.
CONCLUSIONS
Ankle arthrodesis by the anterior approach and the transfibular approach showed comparably good clinical results.

Keyword

Ankle; Osteoarthritis; Arthrodesis

MeSH Terms

Ankle*
Arthrodesis*
Follow-Up Studies
Foot
Humans
Lower Extremity
Orthopedics
Osteoarthritis

Figure

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  Fig. 1 Measurement of the hindfoot alignment. The angle between the mid-diaphyseal axis of the tibia and the mid-diaphyseal line of the calcaneus was measured.

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  Fig. 2 Preoperative standing anteroposterior (A) and lateral (B) radiographs of the ankle showing Takakura stage 4 arthritic change in the right ankle joint. (C, D) Ankle arthrodesis was performed with the anterior approach using two 7.0-mm cannulated screws (C: anteroposterior view, D: lateral view). (E) Follow-up anteroposterior view showing fusion of the ankle joint.

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  Fig. 3 Preoperative standing anteroposterior (A) and lateral (B) radiographs of the ankle showing Takakura stage 3 arthritic change in the left ankle joint. (C, D) Ankle arthrodesis was performed with the transfibular approach with two 7.0-mm cannulated screws and fibular onlay bone graft (C: anteroposterior view, D: lateral view). (E) Follow-up anteroposterior view showing fusion of the ankle joint.

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  Fig. 4 (A) Anteroposterior view showing nonunion after ankle arthrodesis with the anterior approach. (B, C) Revision ankle arthrodesis was performed (B: anteroposterior view, C: lateral view).

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  Fig. 5 (A) Anteroposterior view showing nonunion after ankle arthrodesis with the transfibular approach. (B, C) Revision ankle arthrodesis with a fusion plate was performed (B: anteroposterior view, C: lateral view).

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