Deciding Between Ankle and Tibiotalocalcaneal Arthrodesis for Isolated Ankle Arthritis

Monteagudo, Manuel; Martínez-de-Albornoz, Pilar

doi:10.1016/j.fcl.2021.11.012

Cited by 8 publications

(3 citation statements)

References 66 publications

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“…Monteagudo et al proposed that following isolated arthrodesis of the ankle, the tensile force of the gastrocnemius may develop a gradual shift of the subtalar joint towards the varus, thus limiting the compensating movements in the midtalar joint. Therefore, they suggested stabilizing the subtalar joint in isolated ankle arthrodesis cases [22].…”

Section: Discussionmentioning

confidence: 99%

Anterior Plate-Supported Cannulated Screw Surgery for Ankle Arthrodesis: Clinical and Radiologic Results in Patients with Trauma-Related End-Stage Ankle Osteoarthritis

Gökmen,

Uluöz,

Dülgeroğlu

2024

Med Sci Monit

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Background:This retrospective study included 31 patients from 2 centers in Türkiye with posttraumatic ankle osteoarthritis treated with anterior tibiotalar arthrodesis using an anterior plate and cannulated screw fixation, with 6 months of follow-up. Material/Methods:In this bi-center study, conducted between January 2018 and July 2022, we retrospectively reviewed the digital records of 31 patients with end-stage posttraumatic ankle osteoarthritis who were treated with anterior tibiotalar arthrodesis surgery using 2 or 3 cannulated screws and the anterior plating technique. Data on age, gender, comorbidities, and smoking were recorded, as were operative technique and graft use. Union characteristics, complications, visual analog scale (VAS) results, and Maryland functional scoring were assessed preoperatively and at the 6-month follow-up visit. Results:The mean age of the 31 (n=13 male, n=18 female) patients was 55.5 (19-82) years. The union findings were good in 26 (83.9%) of the patients and late in 3 (9.7%) of them. Nonunion was seen in 2 (6.5%) patients.Complications were observed in 7 (22.6%) patients. Union formation was statistically significantly prolonged among the cases with complications (P=0.002). The smoking rate was significantly higher in patients encountering complications (P=0.001). Among cases with complications, the VAS and Maryland scores recorded in the postoperative sixth month were significantly higher (P=0.027, P=0.018, respectively). The mean union time was 13.5±6.5 weeks among all of the patients. Conclusions:Our study showed that cannulated screw fixation, strengthened with the common and easy-to-supply anterior reconstruction plating technique, had high fixation power and good functional results in patients with endstage posttraumatic ankle osteoarthritis.

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Section: Discussionmentioning

confidence: 99%

Anterior Plate-Supported Cannulated Screw Surgery for Ankle Arthrodesis: Clinical and Radiologic Results in Patients with Trauma-Related End-Stage Ankle Osteoarthritis

Gökmen,

Uluöz,

Dülgeroğlu

2024

Med Sci Monit

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“…6,44,45 Tibiotalocalcaneal fusion has been associated with lower union rates compared with isolated tibiotalar fusion. 37 It is possible that attempting to immobilize 2 major hindfoot joints simultaneously results in a level of strain in one or both, which may affect bone formation and hence union rate. Other known risk factors such as smoking, diabetes, neuropathy, and peripheral vascular disease did not appear to be significant in our analysis, likely because of a small sample size.…”

Section: Radiologic Outcomesmentioning

confidence: 99%

Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction

Tay

Langit²,

Fenton³

et al. 2023

Foot Ankle Int.

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Background: Circular frames for ankle fusion are reserved for complex clinical scenarios. The literature is heterogenous and conflicting. We aim to present the indications and outcomes of this procedure. Methods: A retrospective cohort study based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow-up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiologic and clinical outcomes, and adverse events. Factors influencing radiologic and clinical outcomes were analyzed. Results: 47 patients were included, with a median follow-up of 30 months (interquartile range [IQR] 20-40). The median age at time of surgery was 63.5 years (IQR 58-71). Patients had a median of 2 previous surgeries (IQR 1-3). The median LOS was 8.5 days, and median EFT was 237 days (IQR 166-280). Simultaneous limb lengthening (median 3.3 cm, IQR 1.9-3.5) was performed in 11 patients, increasing the EFT by a mean of 4 months. Primary and final union rates were 91.5% and 95.7%, respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. In addition, 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and reoperations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT. Conclusion: Complex ankle fusion using circular frames can achieve good outcomes, however time in frame may be prolonged with a high rate of adverse events. Identified risk factors for poorer outcomes should be considered in patient counselling and prognostication. Level of Evidence: Level III, prognostic.

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“… 4) Among these, the possible risk of secondary arthritis on the adjacent joint raises arguments on whether preserving the adjacent joint during an isolated tibiotalar (TT) fusion brings about any future benefits with regard to pain and gait discomfort. 5) For this reason, some surgeons suggest primary tibiotalocalcaneal (TTC) fusion over TT fusion, although there is no proven correlation between radiographic changes in the subtalar or midtarsal joint and clinical necessity for a secondary procedure. 6 7) …”

mentioning

confidence: 99%

Midterm Results after Tibiotalar or Tibiotalocalcaneal Fusion Using an Ilizarov External Fixator

Kim,

Panakkal,

Kovoor

et al. 2024

Clin Orthop Surg

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Background Ankle fusion is considered a treatment of choice for end-stage ankle arthritis when a total ankle replacement procedure is not indicated. However, the potential risk of secondary arthritis in the adjacent joint after ankle fusion raises arguments on whether preserving the adjacent joint during an isolated tibiotalar (TT) fusion brings about any future benefits with regard to pain and gait discomfort. In this study, we intended to present midterm results following TT or tibiotalocalcaneal (TTC) fusion using an Ilizarov external fixator and to investigate whether spontaneous fusion occurred in the subtalar or midtarsal joint. Methods This is a retrospective observational study. Medical records of patients who underwent TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint between 1994 and 2018 were manually searched. Forty-one patients were included and the status of the joints adjacent to the fusion site was evaluated in radiographic examinations. Results Of the 34 patients who underwent TT fusion, 30 patients (88.3%) had a spontaneous fusion in the adjacent joints. Specifically, 11 patients (29.4%) had subtalar joint fusion and 19 patients (55.9%) had both midtarsal joint and subtalar joint fusion. In TTC fusion, the midtarsal joint was spontaneously fused in all 7 patients. Conclusions In this study, we observed spontaneous adjacent joint fusion following TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint. Although a careful approach should be made since patients treated in this study may not represent typical candidates that need primary joint-sacrificing procedures, we believe that this study may draw attention from surgeons concerned about the fate of the adjacent joint status after TT or TTC fusion.

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Deciding Between Ankle and Tibiotalocalcaneal Arthrodesis for Isolated Ankle Arthritis

Cited by 8 publications

References 66 publications

Anterior Plate-Supported Cannulated Screw Surgery for Ankle Arthrodesis: Clinical and Radiologic Results in Patients with Trauma-Related End-Stage Ankle Osteoarthritis

Anterior Plate-Supported Cannulated Screw Surgery for Ankle Arthrodesis: Clinical and Radiologic Results in Patients with Trauma-Related End-Stage Ankle Osteoarthritis

Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction

Midterm Results after Tibiotalar or Tibiotalocalcaneal Fusion Using an Ilizarov External Fixator

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