Ankle Arthodesis

1. Ankle
Arthrodesis
Dr. Mirza Zeeshan Sikandar
HO Orthopedics

2. Arthrodesis
 Arthrodesis refers to the fusion of two or more bones in a joint.
 The diseased cartilage is removed, the bone ends are cut off, and the two bone
ends are fused into one solid bone with metal internal fixation.
 Arthrodesis result in relief of pain but at the same time salvage of associated joint;
resulting in restricted/ no movements at that joint.

3. Indications of Arthrodesis
 Painful arthritis
I. infection
II. trauma (most common cause)
III. chronic instability
IV. AVN of the talus
V. inflammatory arthropathy
VI. primary OA

4. neuropathic arthropathy
tumor resection
salvage for failed ORIF
salvage for failed TAA

5. Ankle Arthrodesis
 Ankle arthrodesis is
the fusion of the
tibiotalar joint most
commonly performed
for end-stage arthritis
of the joint.

6. Types of Ankle Arthrodesis
 Subtalar arthrodesis
 Pantalar arthrodesis
 Triple Arthrodesis

7. Subtalar arthrodesis
 The subtalar joint is a complex
joint located below the ankle
joint and is formed by the union
of the heel (calcaneus) and the
talus (ankle) bone.
 The subtalar joint allows side-
side movement of the foot
(inversion & eversion).
 Sub Talar Arthrodesis will result
in fusion of calcaneus and talus.

9. Pantalar arthrodesis
 Pantalar arthrodesis refers to surgical fusion of the ankle, subtalar, talonavicu-
lar, and commonly the calcaneocuboid joints.

10. Triple Arthrodesis
 Triple" arthrodesis
refers to a fusion
procedure of
three joints of the
hindfoot and
midfoot, the
subtalar joint
(talus and
calcaneus), the
talonavicular
joint, and the
calcaneocuboid
joint.

12. Complications of Ankle Joint
 Nonunion
 10% non union rate
 tobacco users have 2.7x risk
 neuropathy is greatest risk factor for persistent nonunion with revision of nonunion
 Lateral plantar nerve injury
 Superficial peroneal nerve
 injury to superficial peroneal nerve during transfibular approach
 Hindfoot arthritis
 adjacent hindfoot arthritis commonly occurs following fusion
 isolated hindfoot arthritis due to chronic pes planus is treated with subtalar joint
arthrodesis

13. Alternative to Ankle Arthrodesis
 Total ankle replacement is a
type of joint
replacement surgery. It's also
called ankle arthroplasty.
 Trials are ongoing about efficacy
of TAR.
 Still preferred modality for ankle
arthritis and pain is Ankle
Arthrodesis.