This document discusses ankle arthrodesis, which refers to the surgical fusion of bones in the ankle joint. The diseased cartilage is removed, the bone ends are cut off and fused together with internal fixation to relieve pain while restricting joint movement. Ankle arthrodesis is commonly performed for end-stage ankle arthritis. There are different types including subtalar, pantalar, and triple arthrodesis, which fuse different ankle and foot joints. Complications can include nonunion, nerve injuries, and adjacent hindfoot arthritis. Total ankle replacement is an alternative but ankle arthrodesis remains the preferred treatment for ankle arthritis.

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.