Ankle Arthrodesis - Ian McDermott 26/6/2001

Ankle arthrodesis was originally a surgical treatment for TB of the ankle.

• Indications now:-

-        persistent ankle-joint pain and stiffness that is functionally disabling to the patient, and is not alleviated by non-operative methods.

-        May be due to             Previous fracture

Previous infection

Primary osteoarthritis

Rheumatoid arthritis

Osteonecrosis of the talus

• If there are degenerative changes in of malalignment of the subtalar joints (the talocalcaneal, talonavicular and calcaneocuboid joints), then an isolated ankle fusion is not appropriate.
• Some biomechanical facts:-

-        1mm of lateral talar displacement increases peak tibiotalar contact pressures by 40%

-        after an ankle fusion, dorsiflexion is decreased 50% and plantarflexion is decreased by 70%. The remaining movement happens in the 'foot' joints

-        after successful ankle arthrodesis, motion in the subtalar complex increases by an average of 11 degrees during the first year.

• Most open procedures require extensive incisions with soft tissue stripping.
• The primary blood supply to the medial aspect of the body of the talus comes from a branch from the posterior tibial artery that passes within the deep fibres of the deltoid ligament.
• Originally, ankle arthrodesis used to be associated with a very high non-union rate.
• Risk of non-union increased x 16 in smokers.
• In 1951 Charnley reported his results of Compression Arthrodesis using an External Fixator (a pin through the tibia and a pin through the neck of the talus, with joining bars.
• Reports of results using Charnley's Ex-Fix range from 10% - 38% non-union.
• More than 30 different procedures for ankle arthrodesis have now been reported.
• Issues of interest:-

Open vs Arthroscopic

Use of Ilizarov

Retrograde Nailing

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