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Ankle
Arthrodesis
Dr. Mirza Zeeshan Sikandar
HO Orthopedics
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.
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
neuropathic arthropathy
tumor resection
salvage for failed ORIF
salvage for failed TAA
Ankle Arthrodesis
 Ankle arthrodesis is
the fusion of the
tibiotalar joint most
commonly performed
for end-stage arthritis
of the joint.
Types of Ankle Arthrodesis
 Subtalar arthrodesis
 Pantalar arthrodesis
 Triple Arthrodesis
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.
Pantalar arthrodesis
 Pantalar arthrodesis refers to surgical fusion of the ankle, subtalar, talonavicu-
lar, and commonly the calcaneocuboid joints.
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.
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
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.
Ankle Arthrodesis.pptx

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Ankle Arthrodesis.pptx

  • 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.
  • 8.
  • 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.
  • 11.
  • 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.