ANKLE FUSION: A DURABLE RESULT THAT CAN HOLD UP TO STRESS James - PowerPoint PPT Presentation

ANKLE FUSION: A DURABLE RESULT THAT CAN HOLD UP TO STRESS James W. Stone, M.D. Assistant Clinical Professor Orthopedic Surgery Medical College of Wisconsin Milwaukee, Wisconsin

DISCLOSURE  NO INDUSTRY CONFLICTS  BOARD OF DIRECTORS ARTHROSCOPY ASSOCIATION OF NORTH AMERICA

ANKLE ARTHRODESIS: INDICATIONS  PAIN  DEFORMITY  INSTABILITY

TRADITIONAL APPROACH: OPEN SURGERY

ARTHROSCOPIC ANKLE ARTHRODESIS: HISTORY HIGH COMPLICATION RATE OF OPEN PROCEDURE 60% OVERALL COMPLICATIONS 20% PSEUDARTHROSIS 5-25% INFECTION

ARTHROSCOPIC ANKLE ARTHRODESIS  SCHNEIDER 1983: CASE REPORT AT AANA MEETING  1996: GLICK, MYERSON, MORGAN, SAMPSON: 34 FUSIONS 33/34 SUCCESSFUL FUSIONS AVG. FUSION TIME 9 WEEKS

SURGICAL PROCEDURE

ANKLE ARTHROSCOPY ANTERIOR PORTAL POSITIONS

ANKLE ARTHROSCOPY POSTEROLATERAL PORTAL

ANKLE ARTHROSCOPY SETUP

STEP 3: SECONDARY DEBRIDEMENT

STEP 4: ABRASION OF SURFACES

STEP 5: ASSESS SURFACES FOR BLEEDING

STEP 7:  REMOVE LEG FROM HOLDER AND EXTEND  HOLD ANKLE IN REDUCED POSITION  DRIVE PINS  PLACE SCREWS  CONFIRM ADEQUATE REDUCTION AND SCREW PLACEMENT

ARTHROSCOPIC ANKLE FUSION ANKLE POSITION  SLIGHT VALGUS  NEUTRAL DORSIFLEXION/PLANTARFLEXION  AVOID HINDFOOT VARUS

FIXATION: TWO MEDIAL PINS

FIXATION: CROSSED TRANSMALLEOLAR PINS

ARTHROSCOPIC ANKLE ARTHRODESIS POSTOPERATIVE CARE  POSTERIOR SPLINT OR 3-D WALKER  NWB 1 WEEK THEN WBAT IN WALKER  MAINTAIN WALKER UNTIL RADIOGRAPHIC FUSION 8-12 WEEKS  ROCKER BOTTOM SHOE

LITERATURE AUTHOR YEAR NUMBER FUSION RATE AVG TIME TO PATIENTS FUSION (wks) Myerson & 1991 17 100% 8.7 Quill DeVriese et al. 1994 10 70% 16 Dent et al. 1993 8 100% NA Corso & 1995 16 100% 9.5 Zimmer Glick et al. 1996 34 97% 9

LITERATURE AUTHOR YEAR NUMBER OF FUSION AVG TIME TO PATIENTS RATE FUSION (WKS) Cameron & 2000 15 100% 11.5 Ullrich Ferkel & 2005 35 97% 11.8 Hewitt Gougoulias et 2007 78 97% 12.4 al. Townshend et 2013 30 97% NA al. Meng et al. 2013 14 100% NA

ARTHROSCOPIC ANKLE ARTHRODESIS O ’ BRIEN, STONE, SHEREFF, JOHNSON  COMPARE 17 OPEN TO 19 ARTHROSCOPIC FUSIONS  CONTROLLED FOR PREOPERATIVE PARAMETERS  ANKLES UNDERGOING OPEN ARTHRODESIS WOULD HAVE BEEN ACCEPTABLE FOR ARTHROSCOPIC PROCEDURE BY PREOPERATIVE CRITERIA: NO VALGUS/VARUS MALALIGNMENT AND PASSIVELY CORRECTABLE TO NEUTRAL

ARTHROSCOPIC ANKLE ARTHRODESIS O ’ BRIEN, STONE, SHEREFF, JOHNSON  FUSION RATE  3/17 NONUNIONS IN OPEN GROUP  1/19 NONUNIONS IN ARTHROSCOPIC GROUP

ARTHROSCOPIC ANKLE ARTHRODESIS O ’ BRIEN, STONE, SHEREFF, JOHNSON  POSTOPERATIVE POSITION  35% IN RECOMMENDED POSITION OF DORSI/PLANTAR FLEXION POSTOP IN OPEN GROUP  79% IN RECOMMENDED POSITION OF DORSI/PLANTAR FLEXION IN ARTHROSCOPIC GROUP

ARTHROSCOPIC ANKLE ARTHRODESIS O ’ BRIEN, STONE, SHEREFF, JOHNSON  COMPLICATIONS  1 DEEP INFECTION (OPEN GROUP)  1 TIBIAL NERVE ENTRAPMENT (OPEN GROUP)  3 POSTERIOR SUBTALAR DJD (OPEN GROUP)  NO POSTOPERATIVE COMPLICATIONS IN ARTHROSCOPIC GROUP

SPORTS PARTICIPATION, FUNCTIONAL OUTCOME, AND COMPLICATIONS AFTER ANKLE ARTHRODESIS: MIDTERM FOLLOWUP KERKHOFF ET AL. FOOT ANKLE INT 2017

KERKHOFF ET AL.  LEVEL III RETROSPECTIVE COMPARATIVE  185 ANKLES MEAN FU 8 YRS  FFI, VAS, FAAM  SPORT PARTIC 79.5% 68.9%  73.1% ABLE TO HIKE, MEDIAN 40 MIN  FAILURE 9.2%, REOPERATION 8.6%

KERKHOFF ET AL  SATISFACTORY FUNCTIONAL OUTCOME AND PAIN REDUCTION  MOST REMAINED ACTIVE SPORTS BUT TREND TO LESS DEMANDING ACTIVITIES  COMPLIC AND FAILURE RATES CONSISTENT W PREVIOUS LITERATURE

Maffulli et al. 2017  OUTCOME OF ANKLE ARTHRODESIS AND ANKLE PROSTHESIS: A REVIEW OF THE CURRENT STATUS  LEVEL III: SYSTEMATIC REVIEW

Maffulli et al. 2017  “ALTHOUGH THERE IS SOME EVIDENCE TO SUPPORT TAR TO CONSERVE ANKLE MOTION AND OFFER IMPROVED FUNCTION AND DECREASED PAIN WITH HIGH SATISFACTION RATES, REVISION RATES FOR TAR ARE SIGNIFICANTLY HIGHER THAN REVISION RATES FOR AA”

DR. BERLET  ATHLETIC POPULATION  ADVOCATES FOR ANKLE REPLACEMENT

DR. STONE  THIS IS MY LIFE  GO FOR AN ANKLE FUSION  GOOD LONG TERM RESULTS  RETURN TO HIGH DEMAND ACTIVITIES

CONCLUSIONS  ANKLE FUSION IS AN APPROPRIATE PROCEDURE TO CONSIDER ESPECIALLY IN YOUNG ACTIVE PATIENTS  ANKLE FUSION CAN BE PERFORMED ARTHROSCOPICALLY IN PATIENTS WITH MINIMAL DEFORMITY WITH HIGH FUSION RATE AND LOW COMPLICATION RATE

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