Ankle Arthrodesis

Ankle Arthrodesis/fusion is the end-stage procedure for the treatment of ankle arthritis. Other options available for treating arthritis of the ankle is Joint Replacement Surgery. So, when selecting between arthrodesis and replacement as the optimum procedure for a patient the important considerations are-

1) Infrastructure: – Well equipped OT and Trained Staff
2) Availability of Implants: – Total Ankle still not available in India even in December 2019.
3) Patient’s expectations after surgery: – Total Ankle tolerated well in urban lifestyle.
4) The longevity of the Implant: – 85% survivorship at 10 years in the best of the series.

In low demand patients and financially sound Individuals, arthroplasty finds favor as the cost of the surgery is above 8000 US$.

On all the above counts’ Fusion/ Arthrodesis scores over Arthroplasty. It has been proven beyond doubt that ankle fusion does not produce a bad walking pattern, while it takes away the pain from an individual whose life is already severely compromised due to painful arthritis of the ankle.

Ankle Arthrodesis can be done by either open or arthroscopic techniques:

  •  Open Technique: – For moderate to severe deformities. Healthy skin is mandatory for open procedures. Various approaches used are Anterior, Lateral, Lateral+medial, Medial & Posterior.
  • Arthroscopic Technique: – For mild deformities i.e. less than 15 degrees of varus or valgus tilt in the coronal plane. Preferred in the presence of compromised skin and diabetic patients.
  • Fixation Methods: – Screws, Anterior Plate, Lateral Plate
     

Plates are used to achieve more stiffness of arthrodesis especially in the presence of osteoporosis.

Fixation by 3 compression screws is biomechanically similar to that of plate
( Clifford C, Berg S, McCann K, Hutchinson B, A biomechanical comparison of internal fixation techniques for ankle Arthrodesis. The Journal of Foot Ankle Surgery 2013;54:188-191).

Authors:-

Dr. Kamal Dureja.
Head of Foot & Ankle Surgery Unit,
Max Smart Superspeciality Hospital, Saket
Website: www.drkamaldureja.com

Dr. Shantanu Bhardwaj.
Fellow in Foot & Ankle Surgery,
Max Smart Superspeciality Hospital, Saket