Radiographic Analysis of Wedge Allograft Correction of Angular Malalignment in Ankle Fusion

Kleiber, Brian D.; Klein, Sandra E.; McCormick, Jeremy J.; Johnson, Jeffrey E.

doi:10.3113/fai.2011.0380

Cited by 7 publications

(4 citation statements)

References 15 publications

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“… 18 Fusion rates in correcting valgus and varus tibiotalar deformities with a femoral head allograft have been comparable with standard ankle fusion rates in previous literature. 19 Although long-term and patient-reported outcomes have not been noted, a recent study reports that using a 3-dimensional custom metal sphere was shown to have a significantly greater fusion rate with a lower graft resorption rate when compared with femoral head allografts in TTC fusion. 20 For cases with large structural bone loss, the cup-and-cone technique previously described serves as a promising procedure to preserve limb length, correct ankle or hindfoot deformities, and achieve fusion in patients undergoing TTC arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer

Hoang

Anthony

Gupta

et al. 2021

Arthroscopy Techniques

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Limb shortening due to structural bone loss in tibiotalocalcaneal arthrodesis is a concern that can negatively impact the patient's gait and weight-bearing. To aid in preventing the risk of limb shortening, the use of a femoral head allograft and intramedullary nail in tibiotalocalcaneal arthrodesis has been shown to successfully preserve limb length in patients with structural bone deficits. We present our technique using a femoral head allograft with a cup-and-cone reamer for the treatment of severe ankle and hindfoot deformity.

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Section: Discussionmentioning

confidence: 99%

Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer

Hoang

Anthony

Gupta

et al. 2021

Arthroscopy Techniques

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“…16 Some studies with allografts have demonstrated high rates of fusion, albeit with low sample sizes. [37][38][39][40] DeFontes et al 37 described a novel technique implementing talar allografts in a series of 6 patients undergoing TTC arthrodesis and reported no nonunions, though follow-up for some patients was inadequate. In a subgroup of 8 patients with bone loss requiring either a femoral head or proximal humeral allograft in combination with bone morphogenic protein, Lucas Y Hernandez et al 39 reported a 100% fusion rate in both subtalar and ankle joints when using a straight Intramedullary (IM) nail.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in a study investigating ankle arthrodesis with allograft supplementation, 2 of 3 (66.7%) patients achieved complete fusion after TTC arthrodeses using a lateral blade plate. 38 Additionally, in 11 patients undergoing TTC fusion with retrograde IM compression nail and femoral head allografts, 9 (82%) achieved fusion. 40 Consistent with these aforementioned studies, we have demonstrated a rate of complete radiographic union, defined as fusion at the ankle and subtalar joints, of 63%, a partial (1 joint) union rate of 88%, and an overall individual joint fusion rate of 75%.…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft

Rogero

Tsai

Fuchs

et al. 2019

Foot & Ankle Specialist

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Background: Tibiotalocalcaneal (TTC) arthrodesis implementing adjunctive allografts is a method of limb salvage for patients with complex hindfoot osseous deficits, though outcome results are limited. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: The authors reviewed 24 TTC arthrodesis procedures with bulk femoral head allografts performed by a single surgeon from 2004 to 2016. Radiographic union at the ankle and subtalar joints along with stability of the allograft were assessed. Patients who had clinically successful arthrodeses were contacted to score the Foot and Ankle Ability Measure—Activities of Daily Living (FAAM-ADL) questionnaire, Visual Analog Scale (VAS) for pain, and Short Form-12 (SF-12) at a mean of 58.0 months (range, 28-102) postoperatively. Results: Complete radiographic union of involved joints was achieved in 15 patients (63%) and in 75% (36/48) of all joints; 21 ankles (88%) were assessed to be radiographically stable at final follow-up. Three patients (13%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 21 patients (88%) did not require additional surgery as of final follow-up. Patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P < .001). The mean VAS for pain significantly improved from 77.2 to 32.9 (P < .001). Male sex (P = .08) and a lateral operative approach (P = .03) both resulted in worse outcomes. Conclusion: Use of a femoral head allograft with TTC arthrodesis can offer improved functional scores and sustained radiographic outcomes. Level of Evidence: Level IV: Case series

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“…[ 1 ] These adverse biomechanical conditions lead to abnormal gait patterns and to increased hindfoot symptoms. [ 1 , 4 , 6 , 9 – 11 ]…”

Section: Introductionmentioning

confidence: 99%

Reliability of the Radiographic Sagittal and Frontal Tibiotalar Alignment after Ankle Arthrodesis

et al. 2016

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BackgroundAccurate measurement of the tibiotalar alignment is important in radiographic outcome assessment of ankle arthrodesis (AA). In studies, various radiological methods have been used to measure the tibiotalar alignment leading to facultative misinterpretation of results. However, to our knowledge, no previous study has investigated the reliability of tibiotalar alignment measurement in AA. We aimed to investigate the reliability of four different methods of measurement of the frontal and sagittal tibiotalar alignment after AA, and to further clarify the most reliable method for determining the longitudinal axis of the tibia.MethodsThirty-eight weight bearing anterior to posterior and lateral ankle radiographs of thirty-seven patients who had undergone AA with a two screw fixation technique were selected. Three observers measured the frontal tibiotalar angle (FTTA) and the sagittal tibiotalar angle (STTA) using four different methods. The methods differed by the definition of the longitudinal tibial axis. Method A was defined by a line drawn along the lateral tibial border in anterior to posterior radiographs and along the posterior tibial border in lateral radiographs. Method B was defined by a line connecting two points in the middle of the proximal and the distal tibial shaft. Method C was drawn „freestyle”along the longitudinal axis of the tibia, and method D was defined by a line connecting the center of the tibial articular surface and a point in the middle of the proximal tibial shaft. Intra- and interobserver correlation coefficients (ICC) and repeated measurement ANOVA were calculated to assess measurement reliability and accuracy.ResultsAll four methods showed excellent inter- and intraobserver reliability for the FTTA and the STTA. When the longitudinal tibial axis is defined by connecting two points in the middle of the proximal and the distal tibial shaft, the highest interobserver reliability for the FTTA (ICC: 0.980; CI 95%: 0.966–0.989) and for the STTA (ICC: 0.997; CI 95%: 0.996–0.999) is provided. Intergroup analysis for FTTA measurements revealed a statistically significant difference between the method in which the lateral border of the tibia was used to determine the longitudinal axis of the tibia, and the other methods in which the longitudinal axis was defined by bisecting the tibia.ConclusionsWhen the longitudinal axis of the tibia is defined by connecting two points in the middle of the proximal and the distal tibial shaft for measuring the FTTA and STTA, the most favorable interobserver reliability is provided. Therefore, this method can be recommended for evaluating the frontal and the sagittal alignment on anterior to posterior and lateral radiographs after ankle arthrodesis.

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Radiographic Analysis of Wedge Allograft Correction of Angular Malalignment in Ankle Fusion

Abstract: The tibiotalar joint fusion rate in this series compares favorably to historically published data for standard ankle fusion. Interposition allograft was an effective method for deformity correction in difficult ankle arthrodeses.

Cited by 7 publications

References 15 publications

Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer

Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer

Midterm Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft

Reliability of the Radiographic Sagittal and Frontal Tibiotalar Alignment after Ankle Arthrodesis

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