Outcomes after Standardized Screw Fixation Technique of Ankle Arthrodesis

Abstract

Several methods of obtaining ankle fusion have been described, with numerous studies reporting on patient populations with varied diagnoses and various methods of fixation. This has led to outcome analyses that are difficult to interpret. Our hypothesis is that using a standard method of fusion, without the aid of allograft, a solid ankle fusion can be achieved in patients with end-stage ankle arthritis, and that this outcome can be reflected in standardized outcome tools. Forty-one consecutive ankle fusions in 40 patients were included in our study, with a minimum followup of 3 years. All patients had an ankle arthrodesis using two parallel retrograde 7.3-mm screws and local fibular graft. All but two patients obtained a solid talocrural union (95%), with a mean postoperative improvement in the American Orthopaedic Foot and Ankle Society score of 23 points. Results of our study showed that a simple technique based on sound mechanical and biologic principles can yield excellent outcomes for patients.

High Union Rates and Function Scores at Midterm Followup With Ankle Arthrodesis Using a Four Screw Technique

“…We agree with other authors that judicious resection of remaining cartilage, sclerotic and nonviable bone while preserving the bone contours results in a highly stable fusion and avoids rotational malalignment [27,34,47,55].…”

“…The functional results as measured with the AOFAS score improved substantially as compared to the preoperative values and compare well to the recent literature (Table 2). Similarly, other authors have reported that between 88% and 98% of patients would undergo ankle arthrodesis again [11,27]. This probably reflects the patients' subjective relief of long-standing pain and disability despite residual functional restrictions.…”

“…While some authors [6,17] noted a worse clinical outcome in the presence of subtalar arthritis, patient satisfaction was still high in these studies. Trichard et al [51] reported less than 1/3, Kennedy et al [27] found one in seven, and Ben Amor et al [4] found none of them clinically relevant. Consequently, only a small proportion of the patients with radiographic subtalar arthritis [27,51]-and none of our patients-had an additional fusion of either of these joints.…”

“…Our observations confirm those of Sheridan et al [43] who reported a high percentage (96%) of subtalar and midfoot arthritis was preexisting due to ankle malfunction in end-stage arthritis. Progression of preexisting arthritis has been reported in between 0 and 70% [5,27,30,48]. Several long-term studies have reported high overall rates of subtalar arthritis of between 47% and 100% [4,6,11,17].…”

“…Long-term studies with followup of more than 20 years revealed a high percentage (ie, 47% to 100%) of arthritis at the adjacent joints [11,17,51]. However, only few studies reported the amount of preexisting arthritis of these joints [5,27,43,48] and the clinical relevance of radiographic signs of arthritis is not entirely clear [4,37,51].…”