Ankle Arthrodesis

2019 ◽  
pp. 96-116
Author(s):  
Jill Berlin ◽  
Thomas Halaszynski
Keyword(s):  
Ankle Joint ◽  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Fusion Surgery ◽  
Ankle Motion ◽  
Ankle Fusion ◽  
Relieve Pain ◽  
Improve Patient

This chapter discusses ankle arthrodesis (i.e., ankle fusion) surgery, the goal of which is to relieve pain and maintain or improve patient function. Candidates for ankle arthrodesis are those in whom more conservative treatments have failed and also those with severe ankle arthritis (degeneration of the cartilage covering the ends of the bones that form the ankle). The bones that form the ankle joint include the tibia, fibula, and talus. Pain can be made worse with movement of the ankle. To reduce pain is to take bones of the ankle and fuse them into one bone (to eliminate ankle motion).

scholarly journals Ankle Distraction Arthroplasty combined with PRP injection for Post-traumatic Ankle Arthritis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Zhongmin Shi ◽  
Wenqi Gu
Keyword(s):  
Ankle Joint ◽  
Plantar Flexion ◽  
Functional Limitation ◽  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Distraction Arthroplasty ◽  
Post Traumatic ◽  
Pin Tract Infection ◽  
American Orthopaedic ◽  
Dorsal Extension

Category: Ankle Arthritis Introduction/Purpose: To summarize and evaluate the surgical technique and clinical outcome of ankle distraction arthroplasty with PRP injection for post-traumatic ankle arthritis. Methods: Totally 21 patients of post-traumatic ankle arthritis were treated at the department of orthopaedic surgery, Shanghai Sixth People’s Hospital. They were 13 males and 8 females with an average age of 32.5±6.2 years. The average course of disease were 14.0±2.8 months. After the failure of conservative management for at least 6 months, ankle distraction arthroplasty with PRP injection was performed in all patients. American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score system and Visual Analogue Scale (VAS) system were used to evaluate the final overall outcome. The range of motion (ROM) of ankle joint and complications were also recorded. Results: Pin tract infection was occurred in two patients, who were cured by alcohol care. 18 patients were followed for an average 36 months. The post-operative AOFAS ankle and hindfoot score was improved from 46.2±7.7 to 79.2±11.6 (t=-14.58, P ＜0.05), while the VAS score was decreased from 6.6±1.1 to 1.8±2.0 (t=16.424, P＜0.0001). The dorsal extension of ankle joint was increased from 1.3±9.3° to 8.1±5.5° (t=-4.675, P＜0.0001) and the plantar flexion was improved from 14.4±6.8° to 26.9±7.3°(t=-7.919, P＜0.05). The radiograph manifested the progressive course of ankle arthritis in four patients, two of which were cured by a salvage ankle arthrodesis by consequence of a failure of conservative treatment for persistent pain and functional limitation. Conclusion: The ankle distraction arthroplasty is an effective ankle preserving surgery, which could relieve symptoms, improve functions and delay the course of post-traumatic ankle arthritis

Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

2021 ◽  
pp. 193864002098092
Author(s):  
Devon W. Consul ◽  
Anson Chu ◽  
Travis M. Langan ◽  
Christopher F. Hyer ◽  
Gregory Berlet
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Implant Survival ◽  
Ankle Arthritis ◽  
Single Institution ◽  
Retrospective Case ◽  
Ankle Replacement ◽  
End Stage

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

FOOSH—OUCH!

2020 ◽  
pp. 151-158
Author(s):  
Victor Huang ◽  
Nima Jalali ◽  
Bryan McCarty ◽  
Philipp J. Underwood
Keyword(s):  
Side Effects ◽  
Soft Tissue ◽  
Soft Tissue Injuries ◽  
Systemic Approach ◽  
Supracondylar Fractures ◽  
Relieve Pain ◽  
Patient Cooperation ◽  
Airway Equipment ◽  
The Right ◽  
Improve Patient

A twelve-year-old boy presents with right wrist pain after a fall onto outstretched hand (FOOSH). The injury was isolated to the right wrist, which was swollen, visibly deformed, but neurovascularly intact distally. Imaging revealed a distal radial and ulna fracture with dorsal displacement. Injuries after a FOOSH include physeal fractures, incomplete fractures, supracondylar fractures, and soft-tissue injuries. Open fractures and neurovascular compromise warrant emergent orthopedic consultation. Displaced fractures should be reduced in the ED and immobilized in a sugar tong splint. Local anesthetics and procedural sedation are important tools to relieve pain and improve patient cooperation. Due to the risks of sedation, physicians should have a systemic approach to evaluate the patient and prepare the monitoring and airway equipment. There are many different medications and routes available. It is important for the physician to be aware of the side effects and discuss this with the patient and parents.

scholarly journals Risk Factors for Nonunion in Arthroscopic and Open Ankle Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
William T. Davis ◽  
Bradley Alexander ◽  
Benjamin B. Cage ◽  
Elise M. Greco ◽  
Charles R. Sutherland ◽  
...  
Keyword(s):  
Risk Factors ◽  
External Fixation ◽  
Significant Risk ◽  
The United States ◽  
Ankle Arthrodesis ◽  
Open Group ◽  
Ankle Arthritis ◽  
Patient Factors ◽  
Tourniquet Time ◽  
Radiographic Union

Category: Ankle; Ankle Arthritis; Arthroscopy Introduction/Purpose: Ankle arthrodesis remains the most popular surgical treatment option for end-stage ankle arthritis (ESAA) among surgeons in the United States. The primary objective endpoint for judging failure versus success of any arthrodesis is radiographic union versus nonunion. Overall, reported union rates in the last two decades have been excellent; however, there does remain significant variation in results with conflicting evidence regarding both treatment and patient factors that are associated with nonunion. We present a relatively large case series of ankle arthrodeses from a single institution with a high-risk patient population with the goal of further clarifying the patient and treatment factors that lead to nonunion. Methods: We conducted a retrospective chart review of 118 patients who underwent primary open or arthroscopic ankle arthrodesis at our institution between November 2014 and April 2019. Revision arthrodesis and patients with a history of complex open fracture were excluded. A minimum 6-month postoperative followup was required. The patients were divided into arthroscopic and open arthrodesis cohorts. The primary outcome measure was radiographic union at 6 months. Patient factors including demographics, BMI, medical comorbidities, and smoking status were analyzed as predictors of nonunion. Likewise, treatment factors such as surgical approach, method of fixation, and tourniquet time were analyzed as predictors of nonunion. Results: Of the 43 individuals that underwent arthroscopic ankle arthrodesis seven progressed to nonunion (16.27%). Among those undergoing open ankle arthrodesis 6 patients out of 46 progressed to nonunion (13.04%). In the arthroscopic cohort, individuals with preoperative lower extremity infection had a significantly higher rate of nonunion compared to those without infection (50.00%, p=0.0447). The open group had two significant predictors of nonunion: use of external fixation and low tourniquet time. Individuals who underwent arthrodesis with the use of an external fixator had a 100% nonunion rate compared to 11.11% for those treated with screws and 0% for those treated with plate fixation (p=0.020). Individuals that had a total tourniquet time under 90 minutes had a non-union rate of 66.67% (p=0.0082). Conclusion: While it was unsurprising that preoperative infection was a significant risk factor for nonunion, it is interesting that this effect was only shown in the arthroscopic group and not the open group. This could have practice implications and warrants further study. Our findings also add to the body of evidence that external fixation is inferior to modern internal fixation techniques for achieving bony fusion. This result may also reflect the poor preoperative prognosis of those requiring external fixation. There remains little evidence that diabetes, smoking, or BMI are significant risk factors for nonunion in primary ankle arthrodesis. [Table: see text]

scholarly journals Conversion of Ankle Fusions to Ankle Replacements

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0051
Author(s):  
Stephen White ◽  
Bruce Cohen ◽  
Carroll Jones ◽  
Michael Le ◽  
W. Hodges Davis
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
Fusion Site ◽  
Foot Function ◽  
Patient Related Outcome ◽  
Improved Function

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis remains a prominent treatment choice for ankle arthritis in a majority of patients. Long term studies have shown a compensatory development of ipsilateral adjacent joint arthritis after ankle arthrodesis, and some patients who receive an ankle arthrodesis develop pain in surrounding joints, or even at the fusion site. As total ankle arthroplasty (TAA) design, instrumentation, and techniques have improved, the use of total ankle arthroplasty has become more widespread. Very few studies have been published on conversion of ankle arthrodesis to ankle arthroplasty, but they have shown improved function and patient-related outcome scores. The purpose of this study was to assess the radiographic, clinical, and patient-reported outcomes of patients undergoing ankle arthroplasty after conversion from a CT-confirmed ankle arthrodesis. Methods: This was a retrospective cohort study of patients with previous CT-confirmed ankle arthrodesis who underwent conversion to total ankle arthroplasty. Minimum follow up was 1 year. Nonunions of ankle arthrodesis were excluded. AOFAS ankle-hindfoot score, foot function index (FFI), pain, revision surgeries, complications, and patient demographics were assessed. Radiographs prior to TAA, and at latest follow-up were also reviewed. Results: 10 patients were included in the study with an average age of 54.5 years. No implants had to be revised. 1/10 (10%) patients had to undergo secondary surgery for heterotopic ossification removal. The same patient had to undergo another subsequent surgery for posterior ankle decompression. 2/10 (20%) patients had a mild talar subsidence of the TAA at latest follow-up, with no patients having tibial subsidence. Talar osteolysis was noticed in 2 patients (20%) at latest follow-up, with no patients having tibial osteolysis. Only one patient (10%) was noted to have a mild valgus alignment of TAA with no varus malalignments. All radiographic changes noted were clinically asymptomatic. The average AOFAS total score was 58 (range 23,89). The mean FFI total score was 41.9 (range 0,90). Conclusion: Conversion of ankle fusion to TAA is a challenging operation but can be a viable option for patients with ongoing pain after an ankle arthrodesis. We noted low revision rates and few complications at 1 year.

Validation of the Ankle Osteoarthritis Scale Instrument for Preoperative Evaluation of End-Stage Ankle Arthritis Patients Using Item Response Theory

2019 ◽  
Vol 40 (4) ◽  
pp. 422-429 ◽  
Author(s):  
Guiping Liu ◽  
Alexander C. Peterson ◽  
Kevin Wing ◽  
Trafford Crump ◽  
Alastair Younger ◽  
...  
Keyword(s):  
Item Response Theory ◽  
Item Response ◽  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Response Theory ◽  
Ankle Osteoarthritis ◽  
Differential Item Function ◽  
Ankle Replacement ◽  
End Stage ◽  
Pain Domain

Background: Significant ankle arthritis results in functional limitations and patient morbidity. There is a need to measure symptoms and the impact of interventions on patient’s quality of life using valid and reliable patient-reported measurement instruments. The objective of this research was to validate the Ankle Osteoarthritis Scale instrument in the preoperative setting using factor analysis, item response theory, and differential item function methods. Methods: This research is based on secondary analysis of patients scheduled for ankle arthrodesis or total ankle replacement in Vancouver, Canada. Participants completed the instrument between September 2014 and August 2017. Item response theory was used to estimate item difficulty and discrimination parameters, controlling for study participants’ underlying level of ankle function. Differential item function was examined for sex, age group, and surgery. There were 88 participants. Results: Modification indices suggested that item 10, “walking around the house,” would better fit the pain domain rather than the disability domain. Items in the pain domain displayed a range of discrimination and difficulty. Items in the disability domain exhibited a range of discrimination, though the disability domain had low difficulty. Differential item functioning for sex, age group, and ankle arthrodesis or total ankle replacement appeared to be ignorable. Conclusion: This evaluation of the Ankle Osteoarthritis Scale found the instrument to be a strong measure of the effect of pain and dysfunction among patients with end-stage ankle arthritis, even when removing items 7 and 8, supporting its prior use in numerous clinical studies. Level of Evidence: Level II, prospective comparative study.

A Survey for End-Stage Ankle Arthritis Treatment: Ankle Arthrodesis Versus Ankle Arthroplasty

2020 ◽  
Vol 59 (2) ◽  
pp. 330-336 ◽  
Author(s):  
Kerry Tai ◽  
Christopher Vannabouathong ◽  
Sohail M. Mulla ◽  
Christina L. Goldstein ◽  
Christopher Smith ◽  
...  
Keyword(s):  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
End Stage

Comparison of outcome in isolated non-deformed end-stage ankle arthritis between ankle replacement, arthroscopic ankle fusion, and open ankle fusion

2016 ◽  
Vol 102 (7) ◽  
pp. S126
Author(s):  
Andrea Veljkovic ◽  
Timothy Daniels ◽  
Mark Anthony Glazebrook ◽  
Peter Dryden ◽  
Murray J. Penner ◽  
...  
Keyword(s):  
Ankle Arthritis ◽  
Ankle Fusion ◽  
Ankle Replacement ◽  
End Stage

scholarly journals Population-based Projections of Ankle Arthrodeses

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Christopher Gross ◽  
Justin Rabinowitz ◽  
Elizabeth Durante
Keyword(s):  
Age Groups ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Utilization Rate ◽  
Future Trends ◽  
United States Census ◽  
Ankle Arthritis ◽  
United States Census Bureau ◽  
Projection Model ◽  
Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is commonly performed for patients with end stage ankle arthritis. However, with improvements in long-term outcomes following total ankle arthroplasty it is possible that rates of ankle arthrodesis will decrease as utilization of ankle arthroplasty increases. The purpose of this study is to assess the current and future trends of ankle arthrodesis utilization. Methods: National Inpatient Sample (NIS) data from 1997-2014 was used to identify trends in the utilization of ankle arthrodesis. United States Census Bureau data from 1997-2014 was used to identify historical population data and future population estimates. A linear regression model was created using Mathematica v11.3 to project future demand for ankle arthrodesis. The data was stratified to show past and future trends based on gender and age. Results: The overall utilization rate of ankle arthrodesis remained relatively constant from 5897 procedures in 1997 to 5330 procedures in 2014. The overall demand for ankle arthrodesis is expected to increase slightly by 15 percent with 6141 procedures projected in 2045. Stratified by age groups, the number of procedures is predicted to decrease by 75% in ages 18-44 and 6% in ages 45-64, and predicted to increase by 133% in ages 65-84 by 2045. Stratified by gender, ankle arthrodesis is predicted to increase by 47% in males and decrease by 14% in females in 2045. Conclusion: Based on our projection model, the rate of ankle arthrodesis is predicted to stay relatively stable overall but decrease in younger populations. A projected increase in total ankle arthroplasty will likely contribute to decreased utilization of ankle arthrodesis. However, ankle arthrodesis will still be a valuable tool in the surgeon’s armamentarium to treat ankle arthritis.

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