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Does foot position in tibiotalar arthrodesis have an effect on development of secondary arthrosis

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Does foot position in tibiotalar arthrodesis have an effect on development of secondary arthrosis

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Abstract

Twenty-nine patients with 30 isolated arthrodeses of the upper ankle done by a resection and compression technique to treat post-traumatic arthrosis or irreparable pilon fractures, were assessed clinically and radiologically 15–32 years (average, 23.5 years) postoperatively. Foot position, talar retrodeviation, and the various angles of the hindfoot were determined by clinical and radiologic evaluation. Eighteen patients (60%) achieved a good or very good result (American Orthopaedic Foot and Ankle Society AOFAS Score more than 70 points). In contrast, the radiologic examination revealed that additional development or increased arthrosis of the hindfoot and midfoot was present in 26 feet. No correlation was found between the foot position in which the arthrodesis was done and the localization and extent of secondary arthrodeses. Arthrodesis done in a neutral position without talar retroposition can be done without deterioration of longterm effects.

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... Durch die nach durchgeführter OSG-Arthrodese teilweise übermäßigen unphysiologischen Belastungen der Nachbargelenke kommt es trotz korrekt durchgeführter Arthrodese zu Anschlussarthrosen . Lattig et al. sahen bei 30 nachuntersuchten OSG-Arthrodesen nach durchschnittlich 23,5 Jahren zwar 55% gute und sehr gute klinische Ergebnisse,jedoch wiesen fast 90% der Rück-und Mittelfüße begleitende arthrotische Veränderungen auf [9]. Diese Nachbararthrosen können dann weitere Arthrodesen notwendig machen , die eine zunehmende Rigidität des Fußes verursachen und zu erheblichen Gehbehinderungen führen. ...
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Ziel bei der Behandlung der Frakturen des oberen Sprunggelenkes ist die Wiederlangung einer optimalen Gelenkfunktion. Prognostische Faktoren sind das Ausma der Verletzung, begleitende Knorpelschden der gelenkbildenden Flchen von Fibula, Tibia und des Talus sowie Alter und Geschlecht der Patienten. Die Prognose wird aber auch entscheidend von der korrekten chirurgischen Versorgung der Frakturen bestimmt. Komplikationen wie Instabilitt, Kompartmentsyndrom, Infektion, Pseudarthrosen, Arthrose und fixierte Fehlstellungen sowie Manahmen zu ihrer Vermeidung und Behandlung werden dargestellt.The therapeutic goal for ankle fractures is to regain optimum function of the ankle. Prognostic factors include the degree of injury, additional lesions of the cartilage forming the joint surface of the fibula, tibia, and talus, and also the age and sex of the patient. The correct surgical treatment of the fractures, however, is crucial for the prognosis. Complications such as instability, compartment syndrome, infection, pseudarthrosis, arthrosis, and fixed malpositions are described as well as means of avoiding and treating them.
Article
The therapeutic goal for ankle fractures is to regain optimum function of the ankle. Prognostic factors include the degree of injury, additional lesions of the cartilage forming the joint surface of the fibula, tibia, and talus, and also the age and sex of the patient. The correct surgical treatment of the fractures, however, is crucial for the prognosis. Complications such as instability, compartment syndrome, infection, pseudarthrosis, arthrosis, and fixed malpositions are described as well as means of avoiding and treating them.
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Arthrodesis of the ankle joint is still an excellent alternative to joint replacement for treatment of advanced arthritis. The long-term results are also excellent even over time periods of more than 24 years. According to the Swedish registry the revision rate is much higher in younger patients compared to older patients and particularly in comparison to arthrodesis. The different extents of osteolysis and a low forgotten joint score are still long-term unsolved problems in prosthetic treatment of the ankle. In contrast, these important factors do not play any role in arthrodesis. The comfort of arthroscopic arthrodesis has become much higher for the patients and can even be used under conditions of reduced perfusion.
Article
Die Arthrodese ist nach wie vor ein Goldstandard in der Behandlung der Arthrose des oberen Sprunggelenks (OSG). Speziell in Fällen mit einer Talusnekrose, großen Knochendefekten der Tibia und ausgeprägten Deformitäten kann nur mit einer Arthrodese ein gutes Resultat erreicht werden. Insbesondere die minimal-invasive Technik mittels Arthroskopie hat das Indikationsspektrum deutlich erweitert. Der Hauptvorteil der Arthrodese ist die sehr hohe Wahrscheinlichkeit der Schmerzfreiheit. Diesbezüglich ist die Arthrodese der Prothese überlegen. Letztlich sind auch die Langzeitergebnisse (über 20 Jahre) ausgezeichnet und werden bisher von der Prothese nicht erreicht. Der Schlüssel zu einem guten Erfolg ist nicht nur die Durchbaurate, sondern vielmehr die ideale Position des Fußes in Relation zur Tibia und zum ganzen Bein. Dieser Beitrag beschreibt detailliert die wichtigen Techniken der OSG-Arthrodese, erklärt deren Vor- und Nachteile und zeigt die wichtigsten Tipps und Tricks, um ein gutes Resultat zu erzielen.
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The most common reason for a revision total ankle replacement procedure is a painful, stiff ankle even after the initial surgery. Limited and conflicting data are available regarding the change in sagittal foot and ankle range of motion after revision total ankle replacement surgery. We sought to determine whether revision total ankle replacements would reduce compensatory midfoot range of motion. In determining this, a novel radiographic measurement system with stable osseous landmarks is used. A retrospective medical record review of patients who had undergone revision total ankle replacement from January 2009 to June 2016 was performed. Thirty-three patients (33 ankles) underwent revision total ankle replacement surgery and met the inclusion criteria with a mean follow-up period of 28.39 ± 14.68 (range 2 to 59) months. Investigation of preoperative and postoperative weightbearing lateral radiographic images was performed to determine the global foot and ankle, isolated ankle, and isolated midfoot sagittal ranges of motion. Statistical analysis revealed a significant increase in ankle range of motion (p = .046) and a significant decrease in midfoot range of motion (p < .001) from preoperatively to postoperatively. The change in global foot and ankle range of motion was not significant (p = .53). For this patient population, the increased ankle range of motion effectively resulted in less compensatory midfoot range of motion.
Article
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The influence of the position of the ankle joint on the gait pattern was examined in 12 patients. All had stable unilateral tibio-talar arthrodesis for posttraumatic osteoarthrosis. Six were fused in 8 to 12 degrees of plantar flexion, six in neutral or calcaneus position. A total of 48 steps with and without shoes was analyzed and compared statistically with 24 steps on the normal side. After arthrodesis in equinus position, lower leg and knee take up an unfavourable position before heel-off, with the result that the center of gravity is elevated more than normal. This is particularly the case barefoot but is also observed when shoes are worn. On the basis of gait evaluation, ankle joint arthrodesis should be performed in the neutral position for both men and women.
Article
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Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.
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We have addressed the notion that the progression of cancer of the uterine cervix is associated with a preferential constraint on the development of a type 1 cellular mediated response, which is necessary to efficiently eliminate (pre)neoplastic cells. Based on the importance of cytokines in the regulation of an appropriate immune response, we have evaluated the expression of IL-12p40, IL-10 and transforming growth factor-beta 1 (TGF-beta1). Using reverse transcriptase-polymerase chain reaction (RT-PCR), the expression of these three cytokines was evaluated in both low-grade (LG) and high-grade (HG) cervical squamous intraepithelial lesions (SIL) and in normal exocervix and transformation zone biopsies. Our results show that the average level of IL-12 increases within both the LG and HG SIL, compared with both control groups. Interestingly, the percentage of HG SIL expressing IL-12p40 was lower compared with LG SIL. In contrast, the expression of IL-10 increased in parallel with the severity of the lesion to a maximal level in HG SIL. Using immunohistochemistry, we ascertained the presence of IL-12 protein in SIL and IL-10 protein in the transformation zone and SIL biopsies. Both IL-12- and IL-10-producing cells were localized in the stroma, not within the SIL. Furthermore, in this study we also observed that the region of the cervix the most sensitive to lesion development, the transformation zone, was associated with higher average levels of the immunosuppressive cytokines IL-10 and TGF-beta1.
Article
Ankle fusion remains the definitive treatment for advanced arthritis of the ankle joint. Internal fixation with cancellous screws has evolved into the method of choice for achieving arthrodesis in primary uncomplicated cases. The method described leads to rapid fusion with a low incidence of infection and a high success rate using readily available cancellous screws. (C) Williams & Wilkins 1993. All Rights Reserved.
Article
The influence of the position of the ankle joint on the gait pattern was examined in 12 patients. All had stable unilateral tibio-talar arthrodesis for posttraumatic osteoarthrosis. Six were fused in 8 to 12 of plantar flexion, six in neutral or calcaneus position. A total of 48 steps with and without shoes was analyzed and compared statistically with 24 steps on the normal side. After arthrodesis in equinus position, lower leg and knee take up an unfavourable position before heel-off, with the result that the center of gravity is elevated more than normal. This is particularly the case barefoot but is also observed when shoes are worn. On the basis of gait evaluation, ankle joint arthrodesis should be performed in the neutral position for both men and women.
Article
A functional assessment of twelve patients after ankle arthrodesis for post-traumatic arthritis was carried out by means of an extensive clinical evaluation and gait analysis after an average follow-up of eight years. A weighted point system was developed to grade ankle function clinically. The data on gait analysis were examined to determine the effect of arthrodesis of the ankle on the over-all pattern of walking. Under conditions of normal daily living while wearing shoes, all patients functioned well after arthrodesis. The gait-analysis data obtained with the patients wearing shoes showed excellent gait characteristics, and the ankle motion that had been lost was compensated for by: (1) motion of the small joints of the ipsilateral foot; (2) altered motion of the ankle in the contralateral limb; and (3) appropriate footwear. While the patients were walking barefooted, some adverse effects of fusion of the ankle were evident. Velocity of gait was slowed and the length of stride was shortened in all twelve patients. One patient whose ankle had been fused in an equinus position had a back-knee deformity during stance phase, and another walked only on his toes when he was without shoes. The gait patterns of all patients were markedly improved when they were wearing shoes with appropriate heel heights.
Article
Arthrodesis of the ankle can result in a painless, normal walking gait. However, complications in ankle arthrodesis can be major, and can occur when anatomy, deformity, or bony deficiency is not properly addressed. Nonoperative treatment should always be considered first, and, if possible, an open or arthroscopic ankle debridement can provide significant pain relief. Arthrodesis should be considered after conservative treatment fails. Infections, deformity, sensory deficiencies, and bony defects require special consideration. The use of bone graft and internal or external compression will enhance the likelihood of a successful arthrodesis.
Article
Ankle arthrodesis treated by external fixation frequently results in complications from pin tract infections, loss of position, nonunion, and malunion. A method of ankle arthrodesis using 6.5-mm cancellous screws as the primary fixation hardware was developed. The most important screw is placed from the posterior malleolus into the neck and head of the talus, and medial and lateral malleolar screws are added to secure fixation. Near-normal anatomy is maintained with this technique because little or no bone, only cartilage, is removed. Earlier cases were all done through an anterior approach. Later, special techniques were developed for placing screws and strain-relieving bone grafting was added to promote union. Twenty-three cases that were treated by the earlier technique are reviewed. The overall fusion rate was 74%. Three conditions (avascular talus, pyarthrosis, and spasticity) were identified that placed patients at high risk for failure of fusion. Of the patients who were not in a high-risk group, only one had a delayed union. When the high-risk patients were not included in the statistics, the fusion rate was 93%. The evolved technique shows great promise for accurate and trouble-free ankle arthrodesis.
Article
Proper positioning of an ankle arthrodesis is crucial, since it will allow compensatory motion to occur in the rearfoot complex. Arthrosis in the rearfoot can be expected several years after fusion; however, malalignment can potentiate rearfoot arthrosis and lead to a painful and nonfunctional gait.
Article
Unlabelled: Findings from biomechanical analyses of gait were used to estimate the optimum position of arthrodesis of the ankle. Nineteen patients who were followed for an average of 10.4 years (range, four to seventeen years) were studied. By including the knee in the analysis as well as studying the effects on gait of different ground conditions, objective data for the weight-bearing extremities in the transverse, sagittal, and coronal planes were generated. Genu recurvatum was shown to be associated with a plantar-flexion position of fusion of the ankle. Laxity of the medial collateral ligament of the knee was noted in twelve patients (63 per cent). Among these patients, in three (16 per cent) the laxity was graded as moderate to severe, possibly due to external rotation of the extremity during gait to avoid rolling over the rigid plantar-flexed ankle. The patterns of gait showed that a valgus position of the arthrodesis is more advantageous and provides more normal gait, particularly on uneven ground. To attain more normal function of the knee and improve performance on rough ground, the optimum position of arthrodesis of the ankle appears to be neutral flexion, slight (zero to 5 degrees) valgus angulation, and approximately 5 to 10 degrees of external rotation. Posterior displacement of the talus under the tibia tends to produce a more normal pattern of gait and decreases the stress at the knee. Clinical relevance: This study has shown the ideal position of fusion of the ankle to be neutral flexion, slight (zero to 5 degrees) valgus angulation of the hind part of the foot, and 5 to 10 degrees of external rotation. This position allows the greatest compensatory motion at the foot and places the least strain on the knee.
Article
One hundred and one tibiotalar arthrodeses were performed using a single surgical technique that has not been previously reported. The average follow-up was ten years (range, two to twenty-five years). The rate of pseudarthrosis was 5 per cent, four to five times less than in other recent large reports. Pseudarthrosis occurred only in patients with a sensory deficit. Secure fusion was radiographically documented in 95 per cent and the functional clinical result was good to excellent in 90 per cent. The ideal fusion position was found to be neutral or slight equinus angulation, and varus-valgus angulation equal to that of the contralateral side. More than 7 degrees of varus angulation of the heel was associated with symptomatic lateral metatarsalgia in all feet in which it occurred. Radiographic measurement documented an average 85 per cent (11-degree) increase in postoperative tarsal motion. Neither symptoms nor function correlated with the degree of tarsal hypermobility.
Article
A biomechanical approach is essential to proper diagnosis of foot and ankle problems. With full knowledge of how the average or neutral foot and/or ankle functions, one can then readily “spot” variations from these “norms”, and thus gain significant clues in solving your patient's complaints. This requires careful observation and recording of attitudes in stance, gait at various speeds, and ranges of motion in small and larger joints. The author has attempted to point out the pertinent methods of such examinations, the range of “norms” based on scientific data, and how to interpret the variations from these “norms”. Furthermore, once your diagnosis has been established, this biomechanical analysis of your patients’ specific complaints and findings, coupled with your patients’ activities and goals, will influence your office and pre-surgical planning.
Article
This study was carried out on 24 patients who underwent 25 ankle fusions. Twenty-four of 25 ankles operated upon by eight different surgeons achieved a solid fusion. A review showed that when the ankle was fused in a neutral position, the patient would, on the average, have 10 degrees of plantar flexion occurring in the midfoot. This motion allowed him to wear most normal foot gear. In gait, the plantar flexion in the foot approximated the plantar flexion in the normal ankle, giving little difficulty. In contrast, those individuals whose ankle was fused in 10 degrees of plantar flexion who also had 10 degrees of plantar motion in the midfoot and no dorsiflexion motion in the midfoot were, in effect, in 10 degrees of equinus. These patients showed a vaulting pattern while ambulating barefoot, but were usually able to accommodate this position while wearing shoes. The patient with a neutral position of the foot and ankle showed a very satisfactory gait in shoes and a much improved barefoot gait. It is concluded that fusion in a neutral position is indicated and that midtarsal motion occurs in the plantar direction but that no dorsiflexion is present in the midtarsal area.
Article
A review of sixty patients who had undergone ankle fusion for post-traumatic arthritis revealed that thirty-five (58 per cent) had the procedure performed within the first year after injury. A total of forty-eight complications occurred in twenty-nine (48 per cent) of the patients. Frequent complication were infection (23 per cent), non-union (23 per cent), inadequate surgical alignment or early loss of position (15 per cent), malunion (12 per cent), and delayed union (7 per cent). The lateral transfibular approach had the highest incidence of complications, and a two-incision approach using the Charnley compression apparatus was the procedure with the fewest complications. Forty-one patients were followed for an average of 7.5 years after operation. Of these, thirty-four (83 per cent) were satisfied with the procedure. Examination of thirty of the forty-one patients at an average of 7.3 years after surgery revealed virtually no subtalar motion but motion of 13 degrees at Chopart's joint. With shoes, patients had a near-normal gait. The roentgenograms revealed a minimum amount of degenerative arthritis at Chopart's joint, which may worsen with time. Varus or valgus angulation of the hind part of the foot was associated with a greater degree of symptoms in the subtalar area as well as the middle of the foot. The neutral position in varus-valgus angulation as well as dorsiflexion-plantar flexion was the optimum position for both men and women. The results of the procedure did not deteriorate with time.
Article
From 1985 to 1987 a total of 95 ankle arthrodesis were performed. The retrospective study showed in most cases a bony healing within 14 weeks with a complication rate of 20%, due to reduced conditions of the soft tissue. The follow up examination of 52 patients showed a good to very good result in 48 cases. Nearly 70% of the patients did not use orthopaedic made-to-measure shoes at the time of follow up. Only 4% were dissatisfied with this procedure. Therefore the arthrodesis of the ankle should be preferred in comparison to the arthroplastik.
Article
Arthroscopically assisted arthrodesis of the ankle was performed in nineteen patients who were selected because they had osteoarthrosis with minimum or no deformity of the ankle. After arthroscopic resection of the synovial membrane, the subchondral bone, and cartilage from the tibial, fibular, and talar articular surfaces, three percutaneous, cannulated, cancellous screws were used for internal fixation. Of these nineteen patients, ten had radiographic evidence of union by the second postoperative month; five, by the third; one, by the fifth; and one, by the sixth. Two patients had a non-union, but a successful open arthrodesis was subsequently performed on one of these patients. At two years, the scoring system of Mazur et al. indicated a poor result in one patient (after a non-union), a fair result in two, a good result in four, and an excellent result in twelve patients. Arthroscopically assisted arthrodesis of the ankle produces good results in patients who have osteoarthrosis of the ankle with minimum or no deformity, and the immediate postoperative morbidity is of very short duration.
Article
Arthroscopic ankle arthrodesis has recently been shown to be an effective procedure with significant advantages when properly indicated. We report on the results of arthroscopic ankle fusion in 16 patients with idiopathic or posttraumatic osteoarthritis and rheumatoid disease. We used standard ankle arthroscopic technique and simple noninvasive distraction with hanging weights. All 16 patients had a successful fusion at an average of 9.5 weeks postoperatively. Complications included 1 lateral cutaneous neuroma, and 1 patient who required removal of screws because of superficial pain. Postoperative evaluation showed complete resolution of pain in 14 of 16 patients and significant improvement in gait. Fourteen of 16 patients were completely satisfied with the result and cosmesis, and only 1 patient required shoe modification. These results substantiate previous reports that arthroscopic ankle arthrodesis is successful, and where indicated, has significant advantages over the open technique.
Article
The purpose of this study was to quantify the effect of selective arthrodesis (stabilization) of the ankle, subtalar, and talonavicular joints on the rotational movement of the tibia and the calcaneus occurring with dorsiflexion/plantarflexion. Six cadaver foot-leg specimens were investigated using an unconstrained testing apparatus. Simulated ankle joint arthrodesis caused a large increase in tibial rotation and calcaneal eversion-inversion. Subtalar and talonavicular stabilization did not cause as large a rotation.
Article
In ankle arthrodeses several clinical and biomechanical studies have shown the superiority of the screw technique over external fixation. As a maximum of stability is a major goal, especially for functional after-treatment or in patients with poor bone stock, the arthrodeses technique at Hannover Medical School is performed with four screws. Two parallel anterior/posterior screws are placed from the tibia to the talus, providing anterior stabilization. One screw posteriomedial has a posterior tension-wiring effect and one screw placed through the fibula to the talus acts against rotational and sagittal translation. From May 1975 to May 1995, 225 ankle arthrodeses with internal or external fixation technique were performed. Complications were found in 47% in the external fixation treatment group (n = 44) and in 10% the patients stabilized with the screw technique (n = 181). Fifty of these 225 patients had a follow-up evaluation after an average of 7.4 years (external fixation, n = 22; screw fixation, n = 28). All patients were examined and scored with three different scoring systems: (1) MHH Score, (2) Clinical Rating System according to Kitaoka et al. (1994) and (3) Outcome Questionnaire for evaluating the overall outcome. The results from the questionnaire were compared to the clinical scores. Retrospective analysis revealed a higher rate of complications for arthrodeses performed by external fixation. The overall results of all three different scoring systems showed a trend in favor of the screw-fixation technique without reaching statistical significance (P > 0.05). The results of the Outcome Questionnaire are statistically as valid as the two clinical scoring systems.
Article
Of 34 ankle fusions (34 patients) performed at our institution between June 1992 and June 1993, 15 utilized a miniarthrotomy technique. This technique involves two 1.5-cm incisions, one medial and one anterolateral, through which the ankle joint cartilage and synovium are debrided. Subchondral bone resection is completed with a high-speed cutting tool, creating a “slurry” that is saved for local bone graft. The ankle is then appropriately positioned (5° of valgus, 0° of dorsiflexion, and neutral rotation), cannulated screws are inserted, the position is checked fluoroscopically, and the wound is closed. The patient receives a short leg cast at 2 weeks and a walking cast at 3 to 5 weeks until there is radiographic and clinical evidence of solid arthrodesis. In our 15 patients, follow-up ranged from 12 to 19 months after surgery and arthrodesis was radiographically evident at a mean of 6.0 weeks (range, 3–15 weeks). Complications were limited to a transient synovitis in 7/15 patients, which lasted approximately 3 weeks and was possibly related to the bone slurry. Although ankle joints with marked malalignment require a more extensive open arthrodesis procedure, this miniarthrotomy technique offers decreased soft-tissue insult, decreased bone stripping, easy application, and rapid healing time for the treatment of severe degenerative changes of the ankle with minimal deformity.
Article
Forty-two patients underwent an arthroscopic ankle arthrodesis utilizing a bi-framed distraction technique and demineralized bone matrix-bone marrow slurry as a graft substitute. The average follow-up was 27 months (range, 12–64 months). The overall complication rate was 55%, including three nonunions (7%), two fractures (4.8%), four pin site infections (9.5%), one deep infection, four hardware problems (9.5%), and four symptomatic painful subtalar joints (9.5%). Overall, 85% of patients were satisfied with their final result. The complication rate was high but most complications were minor and manageable. The demineralized bone matrix and bone marrow did not seem to increase the fusion rate over what has been documented previously for arthroscopic ankle fusions without the use of this graft substitute.
Article
In 26 patients we performed an arthroscopically assisted arthrodesis of the ankle. The patients' ages ranged from 31 to 69 years. The male:female ratio. Sixteen patients had posttraumatic degenerative joint disease, three patients suffered from a previous infection, four patients had rheumatoid arthritis, and three patients had an osteochondritis dissecans in their past history. The time taken for surgery ranged from 65 to 135 min. Compared with open procedures we documented less postoperative swelling and minor use of analgesics. Time of follow-up was a minimum of 6 months and a maximum of 75 months. In 22 patients we found solid fusion at the time of followup. Fusion was accomplished by 2 months postoperatively in four patients, by 3 months in nine patients, by 4 months in another six patients, and by 6 months in 3 patients. Three patients did not evidence any bony fusion, but they were free of pain. In one patient an open revision was necessary. According to our experience, we recommend arthroscopically assisted arthrodesis of the ankle in patients with degenerative joint disease without rotational or varus/valgus malalignment, severe bone defects or neuropathic disease.
Article
Thirty-four ankle arthrodeses performed using an arthroscopic technique were followed for an average of 8 years. The fusion rate was 97% and the average time to fusion was 9 weeks; 86% of patients had good or excellent functional results. There were no wound infections or neurological injuries. There was one malunion and one additional minor complication. The arthroscopic method uses an abrader to denude the joint surfaces of cartilage, followed by screw fixation. The average time to fusion is significantly less than other ankle arthrodesis techniques, which hastens the recovery period. The shorter time to fusion is likely a result of the minimal soft tissue stripping that is performed during the procedure. The low morbidity of this technique eliminates the need for hospitalization in most cases. There were no long-term adverse sequelae. This is the largest reported series of arthroscopic ankle arthrodeses.
Article
Contact areas and peak pressures in the posterior facet of the subtalar and the talonavicular joints were measured in cadaver lower limbs for both the normal limb and after fixation of the tibiotalar joint. Six joints were fixed in neutral, in 5–7° of varus and of valgus. Ten degrees of equinus angulation was also studied. Each position of fixation was tested independently. Neutral was defined as fixation without coronal or sagittal plane angulation compared with prefixation alignment of the specimen. When compared with normal unfused condition, peak pressures increased, and contact areas decreased in the subtalar joint for specimens fixed in neutral, varus, and valgus. However, the change in peak pressure for neutral fusion compared with normal control was not statistically significant ( P > 0.07). Peak pressures for varus and valgus fixation were significantly different from normal ( P < 0.001). Contact areas for all positions of fixation were significantly different from normal ( P < 0.001). Coronal plane angulation, however, also resulted in significantly lower contact areas compared with neutral fixation ( P < 0.001). Contact areas and peak pressures in the talonavicular joint did not appear to be substantially affected by tibiotalar fixation with coronal plane angulation. Equinus fixation qualitatively increased contact areas and peak pressures in the talonavicular and posterior facet of the subtalar joint. Neutral alignment of the tibiotalar joint in the coronal and sagittal planes altered subtalar and talonavicular joint contact characteristics the least compared with normal controls. Therefore, ankle fusion in the neutral position would be expected to most closely preserve normal joint biomechanics and may limit the progression of degenerative arthrosis of the subtalar joint.
Article
A bone graft in the shape of a triangular prism was taken from the anterior surface of the tibia and used in the arthrodesis in 43 joints of 42 patients with primary and secondary osteoarthritis of the ankle. The modified anterior sliding inlay graft method was used. The average period of external immobilization was 5.8 weeks (range, 27-84 days), and followup ranged from 2 years 4 months to 14 years 11 months (average, 7 years 2 months). Nonunion was detected in three (7%) patients: one patient returned to work without additional treatment, and the other two patients underwent followup surgery within 7 months, and bony union was achieved. The final rate of nonunion was 2.3%. After the operation, excellent alleviation of pain was obtained. However, dorsiflexion of the foot decreased from the preoperative average value of 10.5 degrees to the postoperative value of 4.2 degrees, and plantar flexion also decreased from the preoperative value of 24.7 degrees to the postoperative value of 14 degrees. In addition, the range of motion of the subtalar and Chopart joints gradually improved with little effect on daily living activities. The most appropriate position of arthrodesis of the ankle appears to be in the neutral position between dorsal and plantar flexion. In addition, the varus and valgus angle of the hindfoot should be in a neutral or slightly valgus position. Degenerative arthritis developed and advanced in the subtalar joint in 32.5% of the patients, and these degenerative changes were exacerbated in many patients if such changes were present before surgery. Tibial stress fracture occurred in two (4.7%) patients as a complication that was specific to the current surgical method. Thus, the surgical procedure was modified to prevent the onset of tibial stress fracture.
Valutazione clinico-radiografica a lungo termine di pazienti operati di artrodesi di tibio-tarsica
  • S Giannini
  • F Catani
  • F Ceccarelli
  • M Giorlami
  • Gonella
Giannini S, Catani F, Ceccarelli F, Giorlami M, Gonella F. Valutazione clinico-radiografica a lungo termine di pazienti operati di artrodesi di tibio-tarsica. Ital J Orthop Traumat 1998;(Suppl. 14/2): 183–9.
Basic foot science and examination
  • Jahss Mh In
Jahss MH. In: Wickland EH Jr, editor. Basic foot science and examination, 2nd ed. Disorders of the foot and ankle, vol. 1. Philadelphia: WB Saunders Company; 1991. p. 98 –106.
Spä nach Arthrodesen des oberen Sprunggelenkes
  • W Dehoust
  • Schmidt
Dehoust W, Schmidt HGK. Spä nach Arthrodesen des oberen Sprunggelenkes. Akt Traumatol 1989;19:156–61.
Valutazione funzionale a lungo termine di pazienti di artrodesi di arto inferiore
  • S Giannini
  • F Bombardi
  • F Catani
  • F Ceccarelli
  • Paladini M Marcacci
  • Molgora
Giannini S, Bombardi F, Catani F, Ceccarelli F, Marcacci M, Paladini Molgora A. Valutazione funzionale a lungo termine di pazienti di artrodesi di arto inferiore. Ital J Orthop Traumat 1988;(Suppl. 14/2): 225–44.
Die Stellung des Fusses bei der Arthrodese des oberen Sprunggelenkes Stuttgart: Enke
  • Hefti
Hefti F, Die Stellung des Fusses bei der Arthrodese des oberen Sprunggelenkes. Bü des Orthopä, vol. 28. Stuttgart: Enke; 1981.
Valutazione clinico-radiografica a lungo termine di pazienti operati di artrodesi di tibio-tarsica
  • Giannini
Schraubenarthrodese des oberen Sprunggelenks
  • Thermann
Valutazione funzionale a lungo termine di pazienti di artrodesi di arto inferiore
  • Giannini
Spätergebnisse nach Arthrodesen des oberen Sprunggelenkes
  • Dehoust
Langzeitergebnisse nach Arthrodese des oberen Sprunggelenkes
  • Jockheck