OWL: OCOSH Classification/Orthopaedic Procedures/Arthrodesis/Ankle Fusion

2007 Meta-analysis finds comparable intermediate outcomes between total ankle replacement and ankle fusion

Not Available — 2009-10-30 07:00:54 GMT

A systematic review of intermediate and long-term outcomes for total ankle replacement found excellent or good results in 82% of cases who received a second-generation ankle device compared to 72% of cases treated with ankle fusion. In addition, total ankle replacement resulted in a lower revision rate than fusion, according to the study. Steven L. Haddad, MD, and colleagues searched Medline for all relevant articles comparing outcomes between total ankle replacement and ankle fusion published between 1990 and 2005. They also reviewed relevant abstracts from major orthopedic meetings for 2003 and 2004. The researchers focused outcomes for second-generation ankle implants.

2008 ankle arthrodesis or ankle replacement

Not Available — 2009-10-30 07:00:54 GMT

“Significant uncertainty exists about the proper role of ankle arthroplasty in the treatment of ankle arthritis,” said Nelson Fong SooHoo, MD, of the UCLA Center for Surgical Outcomes and Quality, who presented the results of a study comparing the reoperation rates of ankle arthrodesis and ankle replacement during the American Orthopaedic Foot and Ankle Society’s (AOFAS) 2008 Specialty Day program.
“Ankle fusion has been the traditional treatment,” said Dr. SooHoo, “and we’ve seen good functional outcomes. But concerns about adjacent joint arthritis have triggered an ongoing interest in ankle arthroplasty.”

2008 End Stage Ankle Arthritis and Total Ankle Replacement

Not Available — 2009-10-30 07:00:54 GMT

An interview with Jonathan T. Deland, MD
This “end stage” arthritis results in pain, combined with loss of function and mobility - severely limiting normal activity. When this end stage is reached and non-operative options (such as medication, injections, and bracing) have been exhausted, patients are presented with three methods of surgical treatment: ankle fusion (also known as arthrodesis), total ankle replacement (TAR) and, in some cases, distraction arthroplasty.
In our interview with Dr. Deland, we primarily focused on one option in particular – total ankle replacement – and its evolution to an operative procedure that holds much promise today as a valid alternative to ankle fusion for certain patients.

2009 Better function seen in total ankle replacement vs ankle fusion at 2 years

Not Available — 2009-10-30 07:00:54 GMT

In an investigation called "revolutionary" by American Orthopaedic Foot and Ankle Society (AOFAS) Immediate Past President Robert B. Anderson, MD, researchers found better function with total ankle replacement compared to ankle fusion in a 2-year prospective controlled trial using an uncemented, mobile-bearing total ankle device.
Prospective study of a TAR device also finds more complications following the procedure.

Ankle Arthrodesis - Discussion Wheeless

C.R.Wheeless — 2009-10-30 07:00:54 GMT

Discussion of the outcome and factors affecting the result of ankle fusion.

Ankle arthrodesis in rheumatoid arthritis

Moran et al — 2009-10-30 07:00:54 GMT

We have reviewed the results of 30 ankle arthrodeses performed on 26 patients with rheumatoid arthritis. This procedure was associated with a high morbidity, with wound breakdown and infection occurring in 12 cases. Eighteen ankles had fused, six had pain-free fibrous union, and six required further surgery for nonunion. Clinical evaluation, at an average follow-up of 5 years, was based on a modified ankle-grading system with good or excellent results in 14, fair results in nine, and poor in two. Only 4 patients had some residual pain in the ankle, and so, despite the high complication rate, arthrodesis is an effective method of treating the painful, rheumatoid ankle.
Ankle arthrodesis in rheumatoid arthritis: 30 cases followed for 5 years Authors: Christopher G. Moran; Lan M. Pinder; Stephen R. Smith Acta Orthopaedica, Volume 62, Issue 6 December 1991 , pages 538 - 543 full text available

Ankle Arthrodesis Using Antegrade Intramedullary Nail for Salvage of Nonreconstructable Tibial Pilon Fractures Ortho Supersite

Niikura et al — 2009-10-30 07:00:54 GMT

The treatment of nonreconstructable tibial pilon fractures for which the optimal timing for reduction and fixation has been missed is challenging. Ankle arthrodesis may be a treatment option in such cases. We treated 2 patients with nonreconstructable tibial pilon fractures using ankle arthrodesis with an antegrade intramedullary nail. Our method included exposing of the ankle joint through a lateral approach; excising the distal fibula, comminuted fragments, and remaining articular cartilage; inserting an intramedullary nail in an antegrade fashion from the proximal tibia into the talus; insertion of 2 interlocking screws in the talus and the proximal tibia; and autologous bone grafting using the excised distal fibula. At latest follow-up at 2 and 1 year respectively, fusion was complete, and both patients were pain free and could walk without support. When ankle arthrodesis is performed for a tibial pilon fracture, an intramedullary nail is thought to be superior to a plate, which is bulky and may impede soft tissue healing. Moreover, insertion of an intramedullary nail in an antegrade fashion can preserve the subtalar joint, and is therefore preferred over placement in a retrograde fashion. Ankle arthrodesis using this technique can be a useful salvage procedure for a nonreconstructable tibial pilon fracture.
Takahiro Niikura, MD; Masahiko Miwa, MD; Yoshitada Sakai, MD; Sang Yang Lee, MD; Keisuke Oe, MD; Takashi Iwakura, MD; Akihiro Koh, MD; Takaaki Koga, MD; Masahiro Kurosaka, MD ORTHOPEDICS 2009; 32:611

Ankle Arthrodesis Wheeless

C.R.Wheeless — 2009-10-30 07:00:54 GMT

Notes on indications, workup, techniques and complications

Ankle-hindfoot arthrodesis in rheumatoid arthritis improves kinematics and kinetics of the knee and hip

Weiss et al — 2009-10-30 07:00:54 GMT

Conclusions. Our results demonstrate that ankle/hindfoot arthrodesis in RA is an effective intervention to reduce pain and to improve Health Related Quality of Life and functional ability. Moreover, the overlying leg joints experience an improvement in joint motion, muscle-generated joint moments and work during walking. Three-dimensional gait analysis may assist future investigations of the effects of orthopaedic surgery on functional mobility in RA to prevent irreversible disablement.
Ankle/hindfoot arthrodesis in rheumatoid arthritis improves kinematics and kinetics of the knee and hip: a prospective gait analysis study R. J. Weiss, E. Broström, A. Stark, M. C. Wick and P. Wretenberg Rheumatology Advance Access published online on April 4, 2007 Full text

Arthrodesis Ankle Orthofracs

Not Available — 2009-09-27 07:00:54 GMT

Indications
Traumatic arthritis
Avascular necrosis of body of talus (post traumatic)
Infectious arthritis
Equinus deformity not treatable by bracing
Osteoathritis or Rheumatoid arthritis of ankle
Salvage of failed TAR

Comparison of Function After Ankle Fusion and Ankle Replacement

BRUCE J. SANGEORZAN, M.D. — 2009-10-30 07:00:54 GMT

Ankle arthritis differs from that of the hip and knee in that it is most commonly caused by traumatic injury (rather than degeneration or inflammation) and predominantly affects younger males.
• Ankle fusion is a well-established treatment that can improve pain but does so at a loss of motion of the ankle. It doesn’t work well when there is also arthritis in the nearby joints, because it puts extra load on these joints.
• Altered gait after ankle fusion can lead to arthritis in the surrounding small joints over time.
• The role of ankle replacement, while common in Europe, is limited in the US because of uncertainty of its effectiveness relative to ankle fusion.
• UW Medicine faculty surgeons have been treating patients with ankle replacement surgery since 1995. Initially, total ankle joint replacement was used primarily in patients who were not good candidates for fusion.
• To enable a comparison of outcomes from ankle replacement and ankle fusion we initiated a study in 2006 that compares activity and patient satisfaction after these two procedures. BRUCE J. SANGEORZAN, M.D. et al 2009 ORTHOPAEDIC RESEARCH REPORT p66

Long-Term Results Following Ankle Arthrodesis for Post-Traumatic Arthritis

Coester et al — 2009-10-30 07:00:54 GMT

The present series represents the longest follow-up study of ankle arthrodesis to date. Our cohort of patients all had isolated post-traumatic ankle arthritis, and each underwent a successful isolated ankle arthrodesis. At a mean of twenty-two years, the majority of the patients had substantial, and accelerated, arthritic changes in the ipsilateral foot but not the knee. They were often limited functionally by foot pain. Although ankle arthrodesis may provide good early relief of pain, it is associated with premature deterioration of other joints of the foot and eventual arthritis, pain, and dysfunction.
Lisa M. Coester, MD, Charles L. Saltzman, MD, John Leupold, MD and William Pontarelli, MD The Journal of Bone and Joint Surgery 83:219 (2001) Abstract only

Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion

Mader et al — 2009-10-30 07:00:54 GMT

A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot.
Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years).
Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting.
Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion K. Mader, C. C. Verheyen, T. Gausepohl, and D. Pennig Strategies Trauma Limb Reconstr. 2007 April; 2(1): 39–47. full text

Orthobiologic reduced nonunion rates when used in foot and ankle fusions

Not Available — 2009-10-30 07:00:54 GMT

Sixty-patient open-label study shows promise for bone graft substitute.
Alastair S. Younger, MD, FRCSC, and colleagues prospectively studied 60 patients who underwent a combined 180 foot or ankle fusions aided with recombinant human platelet-derived growth factor in a tricalcium phosphate matrix (Augment Bone Graft, formerly GEM OS1; BioMimetic) and were followed for a minimum of 9 months. The investigators discovered that 90% of the patients achieved clinical fusion, which was determined by a clinician's assessment of radiographs and outcome measures for pain, swelling and motion. In addition, they found that 88% of the patients had radiographic union, as evidenced by bony ridging, and 95% of the joints fused clinically.
Report on Younger AS, Daniels TR, Wing K, et al. The use of RhPDGF to promote bone healing in foot and ankle fusions: A prospective study of 130 fusions in 60 patients. Presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting. June 26-28, 2008. Denver.

Tibiotalar Salvage Procedures for Failed Ankle Arthrodesis

Levine & Harrer — 2009-10-30 07:00:54 GMT

Tibiotalar fusion remains the mainstay of surgical treatment for end-stage arthritis of the ankle joint. Pseudoarthrosis may occur for a variety of reasons including concomitant medical illness, previous high energy trauma, sepsis, technical failure, inadequate bone stock and noncompliance. The rate of pseudoarthrosis after ankle arthrodesis has been reported to range from 0% to 41%. A symptomatic nonunion of an ankle fusion can be managed with revision arthrodesis. The patient should be carefully evaluated and any factors contributing to the nonunion should be identified and, if possible, eliminated. Any risk factor which can be controlled, such as smoking, noncompliance, or steroid use, should be addressed prior to surgery. Surgical planning is essential prior to revision arthrodesis. Technical reasons for failure, such as inadequate fixation or poor bony apposition may be evident on radiograph. If infection is found, debridement and treatment with the appropriate antibiotics are necessary. At the time of surgery, all fibrous tissue and avascular bone in the nonunion site must be removed to allow apposition of good bleeding bone. Good bone stock and adequate circulation is critical for a good result. While results comparable to those seen in primary arthrodesis have been reported, revision procedures may be technically difficult with a higher complication rate and decreased patient satisfaction.
Stuart E. Levine, MD, and Michael F. Harrer, MD Medscape General Medicine. 1999;1(1) Full text