Ankle fusion

Ankle fusion, or ankle arthrodesis, is surgery of the ankle to fuse the bones to treat arthritis and for other purposes.^[1] There are different types of ankle fusion surgery. The surgery involves the use of screws, plates, medical nails, and other hardware to achieve bone union.^[1] Ankle fusion is considered to be the gold standard for treatment of end-stage ankle arthritis.^[1] It trades joint mobility for relief from pain. Complications may include infection, non-union, and, rarely, amputation.^[1]

Tibiotalocalcaneal arthrodesis

Tibiotalocalcaneal (TTC) arthrodesis is a special type of ankle fusion.^[2][3][4][5] It is used in select situations, for instance as a salvage therapy in severe complicated cases of ankle deformity or in other situations.^[2][6] One major approach to TTC arthrodesis uses an intramedullary (IM) medical nail.^{[2][7][8][3][4]} A 2011 systematic review reported the rate of bone union to be 87%, with a range of 74 to 93% in different studies.^[7] The average time to union was 4.5 months.^[7] Only 26% of cases of non-union required revision fusion, with the remaining cases being asymptomatic or not being severe enough to require revision.^[7] It was concluded that the nail can oftentimes provide structural support and relief from pain even without union.^[7] The complication rate was 56%, with hardware-related problems comprising a majority of complications.^[7] The rate of reoperation was 22%, with screw removal done in 11.4%, nail removal done in 4.2%, revision fusion done in 3.4%, and amputation in 1.5%.^[7] The review concluded that there is a good fusion rate with TTC arthrodesis using an IM nail but that the surgery has a high rate of complications.^[7] On the other hand, a 2016 review concluded that there was a low rate of complications.^[8]

See also

• Ankle replacement

References

1. Manke E, Yeo Eng Meng N, Rammelt S (2020). "Ankle Arthrodesis - a Review of Current Techniques and Results". Acta Chir Orthop Traumatol Cech. 87 (4): 225–236. PMID 32940217.
2. Shah KS, Younger AS (March 2011). "Primary tibiotalocalcaneal arthrodesis". Foot Ankle Clin. 16 (1): 115–36. doi:10.1016/j.fcl.2010.12.001. PMID 21338935.
3. Burns PR, Dunse A (July 2017). "Tibiotalocalcaneal Arthrodesis for Foot and Ankle Deformities". Clin Podiatr Med Surg. 34 (3): 357–380. doi:10.1016/j.cpm.2017.02.007. PMID 28576195.
4. Asomugha EU, Den Hartog BD, Junko JT, Alexander IJ (March 2016). "Tibiotalocalcaneal Fusion for Severe Deformity and Bone Loss". J Am Acad Orthop Surg. 24 (3): 125–34. doi:10.5435/JAAOS-D-14-00102. PMID 26829585. S2CID 42817431.
5. Kim C, Catanzariti AR, Mendicino RW (April 2009). "Tibiotalocalcaneal arthrodesis for salvage of severe ankle degeneration". Clin Podiatr Med Surg. 26 (2): 283–302. doi:10.1016/j.cpm.2008.12.009. PMID 19389600.
6. Yang, Chalen; Spacek, Ashley E.; Abicht, Bradly P. (2023). "Tibiotalocalcaneal arthrodesis using a posteriorly angled nail for definitive fixation augmented with fibular onlay graft and autogenous tibial bone graft within the surgical technique of retrograde-delivered locked compression nail: A case series". Foot & Ankle Surgery: Techniques, Reports & Cases. 3 (3): 100307. doi:10.1016/j.fastrc.2023.100307. ISSN 2667-3967.
7. Jehan S, Shakeel M, Bing AJ, Hill SO (October 2011). "The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature". Acta Orthop Belg. 77 (5): 644–51. PMID 22187841.
8. Franceschi F, Franceschetti E, Torre G, Papalia R, Samuelsson K, Karlsson J, Denaro V (April 2016). "Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review". Knee Surg Sports Traumatol Arthrosc. 24 (4): 1316–25. doi:10.1007/s00167-015-3548-1. PMID 25715850. S2CID 22264469.