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Dündar A, Ipek D. TIBIOCALCANEAL ARTHRODESIS: A COMPARISON OF ANTERIOR APPROACH AND TRANSFIBULAR APPROACH. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e267148. [PMID: 37876863 PMCID: PMC10592366 DOI: 10.1590/1413-785220233105e267148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/27/2023] [Indexed: 10/26/2023]
Abstract
Objective The aim of this study was to evaluate the clinical and radiologic results and complications of patients who underwent ankle arthrodesis performed by the transfibular approach and anterior approach in end-stage ankle osteoarthritis. Methods Between 2016 and 2022, 41 patients who satisfied the inclusion criteria for this retrospective comparative analysis were included. Of them, 19 patients are included in the anterior approach group and 22 patients are included in the transfibular approach group. The mean age of the participants is 58.9 years. Collected data included the BMI, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale, visual analogue scale (VAS) score, diabetes, smoking, time to fusion, nonunion, union rate, preoperative and postoperative coronal tibiotalar angle and complications. Result The mean time to bone union was 14.3 weeks (range 11-17 weeks) in the anterior approach group, and 11.3 weeks in the transfibular approach group. Statistically significant difference was found between the two groups. Nonunion occurred in one case in the transfibular approach group and three cases in the anterior approach group. There was no significant difference in the nonunion rate between the both groups (p = 0.321). VAS score, and AOFAS score of the two groups were similar and no significant differences were found (p = 0.491, p = 0.448, p = 0.146, p = 0.073, p = 0.173, p = 0.506, respectively). Conclusions A stable and firm ankle arthrodesis and plantigrade foot can be achieved with both transfibular approach and anterior approach technique. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Abdulrahim Dündar
- Hitit University, Erol Olçok Training and Research Hospital, Department of Orthopedics' and Traumatology, Çorum, Turkey
| | - Deniz Ipek
- Hitit University, Erol Olçok Training and Research Hospital, Department of Orthopedics' and Traumatology, Çorum, Turkey
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van den Heuvel SBM, Doorgakant A, Birnie MFN, Blundell CM, Schepers T. Open Ankle Arthrodesis: a Systematic Review of Approaches and Fixation Methods. Foot Ankle Surg 2021; 27:339-347. [PMID: 33419696 DOI: 10.1016/j.fas.2020.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Open ankle arthrodesis (OAA) remains the most widely used operation in end-stage ankle osteoarthritis. However, there is a large variation in terms of approach and fixation methods. The aim of this systematic review was to assess the effect of different approaches and fixation methods on the union rate, complication rate and functional outcome in OAA. METHODS A search of the online databases PubMed, Embase, and Cochrane library was performed to identify patients who underwent OAA with screw- and/or plate-fixation. RESULTS We identified 38 studies, including 1250 patients (1290 ankles). The union rate was 98% (95% CI 0.95-0.99) for the anterior, 96% (95% CI 0.92-0.98) for the lateral and 96% (95% CI 0.68-1.00) for the combined medial/lateral approach. Screw-fixation achieved an overall union rate of 96% (95% CI 0.93-0.98) and plate-fixation 99% (95% CI 0.96-0.99). The overall complication rate was 14%, 16% and 31% for the anterior, lateral and combined medial/lateral approaches respectively. It stood at 18% for screw-fixation and 9% for plate-fixation. The infection rate was 4%, 6% and 8% for the anterior, lateral and combined approaches respectively. Screw-fixation had an infection rate of 6% and plate-fixation 3%. The postoperative AOFAS scores were 76.8, 76.5 and 67.6 for the anterior, lateral and combined approaches respectively and 74.9 for screw- compared to 78.5 for plate-fixation. These differences did not reach statistical significance. CONCLUSION This study, the first of its kind, found little difference in terms of results between approach and fixation method used in OAA. LEVEL OF EVIDENCE Level IIa.
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Affiliation(s)
- Stein B M van den Heuvel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Ashtin Doorgakant
- Trauma and Orthopaedic Department, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Merel F N Birnie
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Chris M Blundell
- Sheffield Foot and Ankle Unit, Orthopaedic Department, Northern General Hospital, Sheffield, United Kingdom
| | - Tim Schepers
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
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Rogero RG, Fuchs DJ, Corr D, Shakked RJ, Raikin SM. Ankle Arthrodesis Through a Fibular-Sparing Anterior Approach. Foot Ankle Int 2020; 41:1480-1486. [PMID: 32762358 DOI: 10.1177/1071100720946740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The open anterior approach to ankle arthrodesis offers a technique that provides several advantages for surgeons, such as easier visualization of the joint for deformity correction and preservation of the malleoli for potential future conversion to total ankle arthroplasty. The purpose of this study was to evaluate clinical, radiographic, and functional outcomes in a large series of patients undergoing open ankle arthrodesis via a fibular-sparing anterior approach. METHODS A retrospective review was performed of patients undergoing primary ankle arthrodesis with a single fellowship-trained foot and ankle orthopedic surgeon between 2009 and 2017. Patients were excluded if an approach other than anterior was performed. Patient-reported outcome measures (Foot and Ankle Ability Measure-Activities of Daily Living [FAAM-ADL], Short-Form 12 [SF-12], and visual analog scale [VAS] pain) were subsequently collected at a minimum of 24 months (2 years) following index surgery, along with outcome satisfaction and likelihood to repeat surgery. Fusion of the tibiotalar joint at the time of last radiographic follow-up was also assessed. Paired t tests were performed to assess change in pre- to postoperative outcomes, while linear regression analysis was performed to identify any patient factors associated with outcomes. Eighty-one patients, including 31 women and 50 men, with a mean age of 51.5 years and a mean follow-up of 58.9 (range, 24-104) months, were included. RESULTS Sixty-two patients reported significant improvement in mean FAAM-ADL (P < .0001), SF-12 Physical Composite Scale (P < .0001), and VAS pain (P < .0001), while the SF-12 Mental Composite Scale also improved, though not significantly (P = .2854). Twelve patients (14.8%) experienced complications following their arthrodesis procedure. Seventy-nine patients (97.5%) achieved fusion at their last radiographic follow-up. Multiple linear regression analysis revealed age (B = 0.071 [0.004, 0.128]; P = .0373) to have a positive association with postoperative VAS pain. CONCLUSION Ankle arthrodesis utilizing a fibular-sparing anterior approach combined with the transarticular screw fixation technique offers surgeons several advantages, along with a low postoperative complication rate, high rate of radiographic evidence of joint fusion, and substantially large improvement in pain and functional levels. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ryan G Rogero
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Daniel Corr
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
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KIM JUNBEOM, LEE BONGJU, JUNG DEUKHEE, JEONG UITAK, CHUNGHAN AN. COMPARING OUTCOMES OF THE ANKLE ARTHRODESIS BY USING TWO DIFFERENT MATERIALS VIA A TRANSFIBULAR APPROACH. ACTA ORTOPEDICA BRASILEIRA 2020; 28:55-59. [PMID: 32425664 PMCID: PMC7224319 DOI: 10.1590/1413-785220202802223986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To compare clinical and radiologic results and complications of patients who
underwent arthrodesis using a transfibular approach with either a cannulated
screw or an anterior fusion plate. Methods: Patients who underwent ankle arthrodesis were divided into two groups
according to the used materials: 6.5 mm cannulated screw (A) and anterior
fusion plate (B). The clinical scores were compared between groups. The
radiologic results were then assessed by union time. The results were
statistically analyzed using SPSS 20. Results: There was no significant difference between both groups in the American
Orthopedic Foot & Ankle Society (AOFAS) score (p =
0.75), and in the visual analog scale (p = 0.42). In group
B, two cases included wound infection at the surgical site. In tt A, the
mean union time was 10.5 ± 2.3 weeks. In group B, it was 7.8 ± 1.3. There
was a statistically significant difference (p = 0.007)
between union time in both groups. Conclusion: Anterior fusion plate is an effective method for shorter union time, but the
surgeon should be careful with the surgical wound at the skin incision site
in the lesion of the distal tibia. Level of Evidence III,
Retrospective comparative study.
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Affiliation(s)
| | - BONG-JU LEE
- Daejeon Sun Medical Center, Republic of Korea
| | | | - UITAK JEONG
- Daejeon Sun Medical Center, Republic of Korea
| | - AN CHUNGHAN
- Daejeon Sun Medical Center, Republic of Korea
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Kim JG, Ha DJ, Gwak HC, Kim CW, Kim JH, Lee SJ, Kim YJ, Lee CR, Park JH. Ankle Arthrodesis: A Comparison of Anterior Approach and Transfibular Approach. Clin Orthop Surg 2018; 10:368-373. [PMID: 30174814 PMCID: PMC6107825 DOI: 10.4055/cios.2018.10.3.368] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 01/02/2018] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of this study was to compare clinical and radiological results of arthrodesis performed by the anterior approach and by the transfibular approach in ankle osteoarthritis. Methods Sixty patients underwent open arthrodesis (38 by the anterior approach and 22 by the transfibular approach). The visual analogue scale score and the American Orthopedic Foot and Ankle Society (AOFAS) score were examined clinically, and radiological examination was performed on the alignment of the lower extremity and bone union. Results Both groups showed significant improvement in AOFAS score (from 39.8 to 58.3 in the anterior approach group and from 44.5 to 60.7 in the transfibular approach group). There was no significant difference in AOFAS score at the last follow-up in both groups. The time to fusion was 13.5 weeks in the anterior approach group and 11.8 weeks in the transfibular approach group. Nonunion occurred in four cases in the anterior approach group and in one case in the transfibular approach group. Conclusions Ankle arthrodesis by the anterior approach and the transfibular approach showed comparably good clinical results.
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Affiliation(s)
- Jeon-Gyo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Jun Ha
- Department of Orthopaedic Surgery, Busan City Medical Center, Busan, Korea
| | - Heui-Chul Gwak
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung-Han Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seon-Joo Lee
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Young-Jun Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Rak Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji-Hwan Park
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Balaji SM, Selvaraj V, Devadoss S, Devadoss A. Transfibular ankle arthrodesis: A novel method for ankle fusion - A short term retrospective study. Indian J Orthop 2017; 51:75-80. [PMID: 28216754 PMCID: PMC5296852 DOI: 10.4103/0019-5413.197549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. MATERIALS AND METHODS 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years). The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scale. RESULTS All cases of ankle fusions (100%) progressed to solid union in a mean postoperative duration of 3.8 months (range 3-6 months). All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34). The mean AOFAS score was 74 (pain score = 32, functional score = 42). We found that twenty patients (68.96%) out of 29, had excellent results, 7 (24.13%) had good, and 2 (6.89%) showed fair results. CONCLUSION Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup.
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Affiliation(s)
- S Muthukumar Balaji
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India,Address for correspondence: Dr. S Muthukumar Balaji, No. 1145, Mardhini Autocare Products, 13th Cross, Chandra Layout 1st Stage, Bengaluru - 560 072, Karnataka, India. E-mail:
| | - V Selvaraj
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India
| | - Sathish Devadoss
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India
| | - Annamalai Devadoss
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India
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