Arthrodesis with the Ilizarov ring ffxator for severe ankle arthritis

Abstract

Introduction End-stage ankle arthritis is a very painful and disabling pathology, associated with deformity. Infection, poor skin condition, chronic smoking, Charcot arthropathy may not only affect selection of treatment method but also union, leading to unfortunate amputation. Ankle arthrodesis is indicated in advanced ankle arthritis. A variety of fixation methods are available for arthrodesis ranging from internal to external fixation. The Ilizarov ring fixator is a dynamic versatile fixation method. It is a biomechanically stable and minimally invasive method which promotes bone union and has advantage of initiating early weight-bearing and simultaneous deformity correction. We describe our experience in Ilizarov ring fixator application for ankle arthrodesis in 5 patients with severe ankle arthritis and their functional outcome.Materials and Methods This retrospective study was conducted in 5 ankle arthrodesis cases using the Ilizarov ring fixator application from July 2021 to October 2022 in the department of orthopaedics, Jaipur national university, India. Average age of patient was 52 years (range, 40-65). Among included patients one patient had chronic osteomyelitis of the distal tibia and severe arthrosis of the ankle joint with a non-healing ulcer, two patients had post-traumatic arthrosis following talus and distal tibia plafond fracture, Charcot ankle arthropathy and tuberculosis of the ankle joint was detected in two patients respectively. Postoperative pain relief, deformity correction and radiological union at the fusion site were defined as success.Results Fusion was achieved in all patients (100%). Early post-operative ambulation and full weight-bearing was initiated in every case. Pin-tract infection was the commonest complication. Shortening due to arthrodesis was less than 2.5 cm so limb lengthening was not done. Frame removal time was 12 to 14 weeks (average time, 13 weeks). Visual analogue scale was used in all cases. It was in the range of 2 to 3 points preoperatively and 7 to 9 post-operatively after arthrodesis. Average follow-up period was 6 months and it is still underway. AOFAS score was used for functional assessment.Conclusion Ilizarov ring fixator application can be considered as versatile, biomechanically stable, minimally invasive method for ankle arthrodesis in severe ankle arthritis associated with poor soft tissue condition, post- traumatic arthritis, infection, deformity, bone loss, Charcot arthropathy.

Evaluation of the effectiveness of ankle arthrodesis options

“…Лечение поздних стадий остеоартроза базируется, в основном, на эндопротезировании или артродезировании ГСС [5,[10][11][12].…”

“…Протезирование ГСС еще не получило широкого распространения [13], хотя его применение в количественном выражении растет с годами [13,14]. В отличие от этого, артродезирование ГСС с момента его разработки в 1879 г. и до настоящего времени считается «золотым стандартом» лечения поздних стадий ОА [9,11,12,15,16].…”

“…Несмотря на то, что артродез ГСС является достаточно хорошо зарекомендовавшим себя в практике, ученые и клиницисты до сих пор сталкиваются с многочисленными проблемами. Например, вызывает споры оптимальный метод фиксации при данном виде операций [3,11,[16][17][18].…”

“…На сегодня разработано более 40 хирургических методов формирования артродеза [11,15,16]. Наиболее распространенные из них классифицируются по типу хирургической фиксации, которая включает внешнюю и внутреннюю (винтами, спицами, пластинами или интрамедуллярными штифтами) [8-11, 16, 17, 19].…”