Title: Arthodesis of the ankle in the presence of a large deformity in the coronal plane
Authors: R. Smith, P. L. R. Wood
Source: The Journal of Bone and Joint Surgery. Vol. 89-B, No. 5, May 2007
PODIATRIC RELEVANCE:
The foot and ankle surgeon is often referred patients with post-traumatic or primary osteoarthritis of the ankle with concomitant deformity. There are several ways to treat such a patient, including bracing, casting, injections, arthroplasty, arthroscopy and even amputation. This study provides a logical, straightforward surgical procedure to address these deformities.
METHODS:
This was a retrospective study consisting of 23 patients (25 ankles) with ankle osteoarthritis and with a deformity in the coronal plane of at least 20° (Range 20-45°). The mean patient age was 62 years. The mean follow-up was 20 months (Range 12-36 months). Six patients presented with posttraumatic arthritis, while the remainder demonstrated primary osteoarthritis. Surgical exposure was achieved via anterior approach, and fixation consisted of 2 parallel 6.5mm cannulated screws. A wool and crepe dressing was applied in the operating room, and a cast was applied between the 1st and 3rd postoperative days. Patients were immediately allowed to bear weight as tolerated.
RESULTS:
One patient (4%) developed a nonunion and was subsequently treated with 10 weeks of immobilization. The patient remained symptomatic and underwent revision with bone grafting and, at 24 months following the primary procedure, returned to full activity with mild pain. The other 24 ankles healed primarily, and AOFAS mean pain score improved from 10.5/50 preoperatively to 35.2/50 at last visit. All patients were able to walk further postoperatively. The mean AOFAS preoperative function score was 25.5/50, improving to 43.7/50 at follow-up. All patients were satisfied with the results in regards to reduction in pain, walking distance, and the overall result. The mean correction attained in the coronal plane was 25° (Range 15-41°).
COMMENTS:
The results of this study demonstrate that ankle arthrodesis is a useful procedure for arthritic ankles with large deformities it the coronal plane, since arthroplasty is relatively contraindicated in cases of deformity = to 15°. It should be noted that joints adjacent to the arthrodesis incur greater stress and higher rates of arthritis. The authors did not mention whether they evaluated for clinical or radiographic degenerative changes, and a longer follow-up would be helpful to gauge whether their patients develop arthritis at the surrounding hindfoot joints. Although all patients showed improved pain and function postoperatively there was little improvement in the ability to climb stairs, demonstrating that the arthrodesed ankle will not function favorably in all activities.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.