Ankle fusion explained

Ankle fusion, or ankle arthrodesis, is surgery of the ankle to fuse the bones to treat arthritis and for other purposes.[1] There are different types of ankle fusion surgery. The surgery involves the use of screws, plates, medical nails, and other hardware to achieve bone union. Ankle fusion is considered to be the gold standard for treatment of end-stage ankle arthritis. It trades joint mobility for relief from pain. Ankle fusion has also been used to resolve foot drop in certain circumstances.[2] [3] Complications of ankle fusion may include infection, non-union, and, rarely, amputation.

Outcomes

A randomised controlled trial comparing ankle replacement with ankle fusion found that both led to similar improvements in walking, standing and quality of life. Fixed bearing (but not mobile bearing) ankle replacements outperformed ankle fusion in a separate analysis. A cost-effectiveness analysis revealed that ankle replacement may be better value for money over the course of a person's lifetime.[4] [5] __TOC__

Tibiotalocalcaneal arthrodesis

Tibiotalocalcaneal (TTC) arthrodesis is a special type of ankle fusion.[6] [7] [8] [9] It is used in select situations, for instance as a salvage therapy in severe complicated cases of ankle deformity or in other situations.[10] One major approach to TTC arthrodesis uses an intramedullary (IM) medical nail.[11] [12] A 2011 systematic review reported the rate of bone union to be 87%, with a range of 74 to 93% in different studies. The average time to union was 4.5 months. Only 26% of cases of non-union required revision fusion, with the remaining cases being asymptomatic or not being severe enough to require revision. It was concluded that the nail can oftentimes provide structural support and relief from pain even without union. The complication rate was 56%, with hardware-related problems comprising a majority of complications. The rate of reoperation was 22%, with screw removal done in 11.4%, nail removal done in 4.2%, revision fusion done in 3.4%, and amputation in 1.5%. The review concluded that there is a good fusion rate with TTC arthrodesis using an IM nail but that the surgery has a high rate of complications. On the other hand, a 2016 review concluded that there was a low rate of complications.

Bilateral ankle fusion

Ankle fusion is usually done only unilaterally, but more rarely, bilateral ankle fusions have been performed.[13] [14] [15] [16]

See also

Notes and References

  1. Manke E, Yeo Eng Meng N, Rammelt S . Ankle Arthrodesis - a Review of Current Techniques and Results . Acta Chir Orthop Traumatol Cech . 87 . 4 . 225–236 . 2020 . 10.55095/achot2020/035 . 32940217 .
  2. Fahmy FS, Salam MA, Mahmoud HF . Improvement in clinical outcome and quality of life after arthroscopic ankle arthrodesis in paralytic foot drop . J Orthop Surg Res . 18 . 1 . 202 . March 2023 . 36918915 . 10015676 . 10.1186/s13018-023-03691-y . free .
  3. Seidel J, Mathew B, Marks J . Bilateral Ankle and Subtalar Joint Fusion Secondary to Guillain Barré-Induced Foot Drop . J Foot Ankle Surg . 55 . 2 . 260–2 . 2016 . 25128306 . 10.1053/j.jfas.2014.06.020 .
  4. Goldberg . Andrew J. . Chowdhury . Kashfia . Bordea . Ekaterina . Blackstone . James . Brooking . Deirdre . Deane . Elizabeth L. . Hauptmannova . Iva . Cooke . Paul . Cumbers . Marion . Skene . Simon S. . Doré . Caroline J. . 2023-03-30 . Total ankle replacement versus ankle arthrodesis for patients aged 50 85 years with end-stage ankle osteoarthritis: the TARVA RCT . Health Technology Assessment . EN . 27 . 5 . 1–80 . 10.3310/PTYJ1146 . 2046-4924 . 10150410 . 37022932.
  5. 9 January 2024 . Severe ankle osteoarthritis: which surgery should I have? . NIHR Evidence. 10.3310/nihrevidence_61707 . 266915564 .
  6. Shah KS, Younger AS . Primary tibiotalocalcaneal arthrodesis . Foot Ankle Clin . 16 . 1 . 115–36 . March 2011 . 21338935 . 10.1016/j.fcl.2010.12.001 .
  7. Burns PR, Dunse A . Tibiotalocalcaneal Arthrodesis for Foot and Ankle Deformities . Clin Podiatr Med Surg . 34 . 3 . 357–380 . July 2017 . 28576195 . 10.1016/j.cpm.2017.02.007 .
  8. Asomugha EU, Den Hartog BD, Junko JT, Alexander IJ . Tibiotalocalcaneal Fusion for Severe Deformity and Bone Loss . J Am Acad Orthop Surg . 24 . 3 . 125–34 . March 2016 . 26829585 . 10.5435/JAAOS-D-14-00102 . 42817431 .
  9. Kim C, Catanzariti AR, Mendicino RW . Tibiotalocalcaneal arthrodesis for salvage of severe ankle degeneration . Clin Podiatr Med Surg . 26 . 2 . 283–302 . April 2009 . 19389600 . 10.1016/j.cpm.2008.12.009 .
  10. Yang . Chalen . Spacek . Ashley E. . Abicht . Bradly P. . 2023 . Tibiotalocalcaneal arthrodesis using a posteriorly angled nail for definitive fixation augmented with fibular onlay graft and autogenous tibial bone graft within the surgical technique of retrograde-delivered locked compression nail: A case series . Foot & Ankle Surgery: Techniques, Reports & Cases . 3 . 3 . 100307 . 10.1016/j.fastrc.2023.100307 . 259256059 . 2667-3967.
  11. Jehan S, Shakeel M, Bing AJ, Hill SO . The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature . Acta Orthop Belg . 77 . 5 . 644–51 . October 2011 . 22187841 .
  12. Franceschi F, Franceschetti E, Torre G, Papalia R, Samuelsson K, Karlsson J, Denaro V . Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review . Knee Surg Sports Traumatol Arthrosc . 24 . 4 . 1316–25 . April 2016 . 25715850 . 10.1007/s00167-015-3548-1 . 22264469 .
  13. Maenohara Y, Taniguchi A, Tomiwa K, Tsuboyama D, Kurokawa H, Kumai T, Tanaka S, Tanaka Y . Outcomes of Bilateral vs Unilateral Ankle Arthrodesis . Foot Ankle Int . 39 . 5 . 530–534 . May 2018 . 29334782 . 10.1177/1071100717749505 . 19073698 .
  14. Henricson A, Kamrad I, Rosengren B, Carlsson Å . Bilateral Arthrodesis of the Ankle Joint: Self-Reported Outcomes in 35 Patients From the Swedish Ankle Registry . J Foot Ankle Surg . 55 . 6 . 1195–1198 . 2016 . 27614825 . 10.1053/j.jfas.2016.07.014 .
  15. Houdek MT, Wilke BK, Ryssman DB, Turner NS . Radiographic and functional outcomes following bilateral ankle fusions . Foot Ankle Int . 35 . 12 . 1250–4 . December 2014 . 25249317 . 10.1177/1071100714551947 . 23729084 .
  16. Vaughan P, Gordon D, Goldberg A, Cullen N, Singh D . Patient satisfaction and function after bilateral ankle arthrodeses . Foot Ankle Surg . 21 . 3 . 160–3 . September 2015 . 26235853 . 10.1016/j.fas.2014.11.001 .

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