Ankle arthrodesis: A systematic approach and review of the literature

Abstract

Ankle arthrodesis is a common treatment used for patients with end-stage ankle arthritis (ESAA). The surgical goal of ankle arthrodesis is to obtain bony union between the tibia and talus with adequate alignment [slight valgus (0°-5°)], neutral dorsiflexion, and slight external rotation positions) in order to provide a pain-free plantigrade foot for weightbearing activities. There are many variations in operative technique including deferring approaches (open or arthroscopic) and differing fixation methods (internal or external fixation). Each technique has its advantage and disadvantages. Success of ankle arthrodesis can be dependent on several factors, including patient selection, surgeons' skills, patient comorbidities, operative care, etc. However, from our experience, the majority of ESAA patients obtain successful clinical outcomes. This review aims to outline the indications and goals of arthrodesis for treatment of ESAA and discuss both open and arthroscopic ankle arthrodesis. A systematic step by step operative technique guide is presented for both the arthroscopic and open approaches including a postoperative protocol. We review the current evidence supporting each approach. The review finishes with a report of the most recent evidence of outcomes after both approaches and concerns regarding the development of hindfoot arthritis.

Keywords: Ankle; Ankle fusion; Arthrodesis; Osteoarthritis; Review.

Figure 1

Lateral transfibular approach.

Figure 2

Anteroposterior scheme shows the placement of screws.

Figure 3

Any remaining cartilage on the tibia, the talus or in the medial or lateral gutters is debrided.

Figure 4

Kirschner wires should be altogether inserted at the tibial joint surface. A: Arthroscopic view shows the location of the Kirschner wires; B: Fluoroscopic view shows location of Kirschner wires; C: Screw fixation.