Combined Transfibular and Anterior Approaches Increase Union Rate and Decrease Non-Weight-Bearing Periods in Ankle Arthrodesis: Combined Approaches in Ankle Arthrodesis.

Jeong-Jin Park,In-Ha Woo,Chul-Hyun Park,Whee-Sung Son

doi:10.3390/jcm10245915

Abstract

The transfibular approach is a widely used method in ankle arthrodesis. However, it is difficult to correct coronal plane deformity. Moreover, it carries a risk of nonunion and requires long periods of non-weight-bearing because of its relatively weak stability. We hypothesized that the transfibular approach combined with the anterior approach in ankle arthrodesis wound yield a higher fusion rate and shorter non-weight-bearing period. This study was performed to evaluate the clinical and radiographic results and postoperative complications in ankle arthrodesis using combined transfibular and anterior approaches in end-stage ankle arthritis. Thirty-five patients (36 ankles) with end-stage ankle arthritis were consecutively treated using ankle arthrodesis by combined transfibular and anterior approaches. The subjects were 15 men and 20 women, with a mean age of 66.5 years (46–87). Clinical results were assessed using the visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) scores, and the ankle osteoarthritis scale (AOS) preoperatively and at the last follow-up. Radiographic results were assessed with various radiographic parameters on ankle weight-bearing radiographs and hindfoot alignment radiographs. All clinical scores significantly improved after surgery. Union was obtained in all cases without additional surgery. Talus center migration (p = 0.001), sagittal talar migration (p < 0.001), and hindfoot alignment angle (p = 0.001) significantly improved after surgery. One partial skin necrosis, two screw penetrations of the talonavicular joint, and four anterior impingements because of the bulky anterior plate occurred after surgery. In conclusion, combined transfibular and anterior approaches could be a good method to increase the union rate and decrease the non-weight-bearing periods in ankle arthrodesis.

Highlights

Ankle arthrodesis has been commonly used in the treatment of end-stage ankle arthritis because of its straightforward procedure and suitability for almost all types of ankle arthritis
Several approaches have been commonly used for ankle arthrodesis, including the anterior, transfibular, posterior, and arthroscopic approaches [4,5,6]
Various methods have been attempted to increase the stability of the arthrodesis site [9,10,11,12]

Summary

Introduction

Ankle arthrodesis has been commonly used in the treatment of end-stage ankle arthritis because of its straightforward procedure and suitability for almost all types of ankle arthritis. There is high level of evidence in the literature for the use of ankle arthrodesis in the surgical treatment of end-stage ankle arthritis [1,2,3]. In a recent systematic review, the average union rate following ankle arthrodesis was 89% (range: 64–100%) [8]. It is commonly recommended in the literature to keep non-weight-bearing for 8 to 12 weeks after surgery [6,7]. These are related to the rigidity of the arthrodesis construct. Various methods have been attempted to increase the stability of the arthrodesis site [9,10,11,12]

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Discussion

Conclusion