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Abstract
Purpose:
The purpose of this study was to compare the clinical and radiologic results of arthrodesis between anterior approach and transfibular approach arthrodesis in ankle arthritis.
Materials and Methods:
There were 61 cases of ankle arthritis treated by anterior or transfibular ankle arthrodesis in our hospital from April 2008 to March 2012. We investigated 29 cases (27 patients) who underwent ankle arthrodesis with an anterior approach (15 cases) and transfibular approach (14 cases), and were followed for over two years. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analogue scale (VAS), and subjective satisfaction degrees were evaluated. In addition, ankle coronal and sagittal alignments were evaluated using plain radiographs at 6 and 24 months, postoperatively.
Results:
Clinically, preoperative mean AOFAS score and VAS was 41.3 and 6.4, and were changed to 58.9 and 3.3 postoperatively in the anterior approach group. In the transfibular approach group, preoperative mean AOFAS score was 36.6 and VAS was 7.1, and they were changed to 54.9 and 3.4 postoperatively. However, no significant differences in the clinical results were observed between the two groups (p=0.297). Duration of attaining union was 8.1 weeks in the anterior approach group and 10.4 weeks in the transfibular approach group. Complications were delayed union in one case, nonunion in three cases, cancellous screw breakage in three cases, and complex regional reflex syndrome in one case.
Conclusion:
After transfibular ankle arthrodesis as treatment of ankle osteoarthritis, the tendency for valgus angulation of the ankle at the final follow-up was observed and 6.5 mm cancellous screw breakage occurred frequently. Therefore, in order to achieve better stability, it is necessary to use 6.5 mm cannulated screws rather than 6.5 mm cancellous screws for ankle arthrodesis.
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Figure 1.
(A) Preoperative standing radiograph shows medial compartment ankle osteoarthritis. Ankle arthrodesis was performed with anterior approach using three cannulated screws (B, anteroposterior view; C, lateral view). (D) Last follow-up radiograph shows complete bony union without breakage or loosening.
Figure 2.
Measurement method for the long axial view. We defined the mid-diaphyseal axis of the tibia by bisecting the tibia into two mid-diaphyseal points (lines a and b) 30 mm apart and extending the line distally (linee). The mid-diaphyseal axis of the calcaneus is defined by a line through two points in the calcaneus. At a distance of 7 mm from the most distal part of the calcaneus, a horizontal line is drawn (line d). Lined is divided into a 40%:60% ratio, where the length of the 40% line is measured from the lateral side. A second line (linec) is drawn horizontally, 30 mm from the most distal part of the calcaneus. The calcaneus axis (line f) is drawn by connecting the 40% mark at lined and the bisected line c. The hindfoot angle (g) is the angle between lines e and f. Revised from the article of Reilingh, et al. (Skeletal Radiol. 2010;39:1103-8).11)
Figure 3.
(A) Preoperative standing radiograph shows medial compartment ankle osteoarthritis. (B) Ankle arthrodesis was performed with trans-fibular approach using three cancellous screws. (C) Follow-up radiograph shows breakage of cancellous screws and valgus tibiotalar alignment. (D) Revision arthrodesis with cannulated screws was performed and bony union was evident 2 months after surgery.
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