Ankle Arthrodesis, Approach and Surgical Techniques.pptx

ANKLE ARTHRODESIS
Suresh Pandey
Professor and Head
Orthopedics, COMS
NOA Chitwan Ankle foot Symposium 2024

PROBLEM STATEMENT
 Disabling end stage arthritis common
 Options of treatment varies with variable outcome
 4 AA /100,000 population

ANATOMY

STABILITY

HISTORY: ANKLE ARHRODESIS
 Fusion ofTibiotalar joint
 Coined by the Austrian surgeon
Eduard Albert in 1878
 Common procedure for end stage
ankle arthropathy

WHY ANKLE ARTHORDESIS
 Indications
 End stage disabling arthritis
 Post-Traumatic (70%)
 Infection
 AVN
 RA
 Gout
 Inflammatory arthropathy

INDICATIONS OF ARTHRODESIS…
 Failed arthroplasty
 AVN
 Deformity
 Charcot Joint

RELATIVE CONTRAINDICATIONS
 Poor vascularity
 Marked Peripheral neuropathy
 Severe deformity

ARTHORDESISVS ARTHROPLASTY
 Indications and Superiority

FUSION HAS HIGHER RATE OF
 Wound dehiscence
 Nonunion
 Infection

ARTHRODESIS: IS IT GOLD STANDARD?
 Higher complications rate (up to 40%)
 Loss of motion
 Adjacent joint degeneration
 Inferior satisfaction rate

WHAT HAS CHANGED?
 Better results with fewer complications
 Fusion rate 90-99 percent
 Better soft tissue care
 Better implant and fixation

SURGICALTECHNIQUE
 >30 techniques described
 Open: Moderate to severe deformity
 Arthroscopic: Mild or no deformity
 Poor skin condition
 Higher risk of wound complications

CONTRAINDICATIONS OF ARTHROSCOPIC
ARTHRODESIS
 Large bone defect
 Moderate to severe deformity
 Active infection
 Previous failed arthrodesis

GOAL
 Plantigrade foot, painless walking with minimal limb length discrepancy

APPROACHES
 Anterior
 Lateral
 Medial
 Posterior
 Combined

ANTERIOR
 Most common
 Good exposure
 Useful for coronal plane displacement
ofTalus
 Plane betweenTA medially and EHL
along with NV bundle laterally
 Between EHL and EDL alternatively

ANTERIOR
Take care of Medial and
Intermediate branch of cut n
Incise Retinaculum and Capsule

INTRAOP ATTENTION
 Adequate exposure
 Respect to soft tissue
 Adequate debridement
 Proper bed, contact surface and fixation

TECHNIQUES OF SURFACE PREPARATION
 Curette
 Chisel/osteotome
 Rounger
 Burr
 Saw
 Drill
 Malleolar osteotomy

TECHNIQUES OF FIXATION
 Internal
 External: Active Infection or poor skin condition
Inferior results

INTERNAL FIXATION HARDWARE
 Screws
 Plate
 Retrograde Nail
 Plate and screws

INTERNAL FIXATION: BEST CHOICE?
 Plate
 Screw
 Nail (subtalar fusion)
 combination

CONFIGURATION AND NUMBER OF
SCREWS
 2 or more
 Parallel,
 cross
 Antegrade
 Retrograde
 Combinations

POSITION OF FUSION
 0-5 deg valgus
 Neutral
 0-5 deg ER
 Talus at centre in AP and Lat
view
 Slight posterior position of
Talus to use maximum contact
surface and reduce anterior
lever arm

AVOID…
 Anterior position ofTalus
 Over-resection and shortening
 Lateral malleolus impingement

ROLE OF BG
 Bone loss
 Failed arthrodesis
 Gap
 Higher fusion rate
 Avoid valgus/varus

POSTOP REHAB
 6 weeks of non-wt bearing cast
 Gradual to full wt bearing as per union assessment

FUSION RATE
 89% (64%-100%)
 Arthroscopic arthrodesis was 94% (range: 70%-100%)

WHATWOULD BE LIFE LIKE?
 Painless stable joint
 Gait Speed
 Break reaction time
 Adjacent joint arthropathy due to excess stress and compensatory mobility

IMPORTANTTAKE AWAYS
 Proper selection of patient
 Respect to soft tissue
 Proper joint preparation
 Stable fixation
 Address bone loss/gap

THANKYOU
Thank you

Ankle Arthrodesis, Approach and Surgical Techniques.pptx

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