Compromise of Adjacent Joints in Long-Term Evolution of Ankle Arthrodesis
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Published:
Apr 16, 2024
Keywords:
Ankle osteoarthritis, ankle arthrodesis, adjacent joints
Main Article Content
Abstract
Introduction: Tibiotalar arthrodesis is an option in the treatment of ankle osteoarthritis in patients who do not respond to conservative measures. Its main disadvantage is the compromise of adjacent joints in the medium and long term.
Objective: To determine the involvement of adjacent joints in the medium and long term and its impact on functional outcomes in patients with ankle arthrodesis.
Materials and Methods: We evaluated a series of 11 patients, 6 females and 5 males. The initial diagnosis was post-traumatic osteoarthritis (9 cases), septic arthritis (1 case), and osteochondral lesion of the talus (1 case). The mean age at the time of surgery was 50 years. The mean follow-up was 9 years. The radiographic compromise of the adjacent joints was evaluated. The patients were functionally evaluated using the Visual Analog Pain Scale (VAS), the AOFAS scale (American Orthopedic Foot and Ankle Score), and a simple satisfaction questionnaire.
Results: 10 patients (91%) presented with osteoarthritis of one of the adjacent joints. The average score on the VAS was 2.6, while on the AOFAS scale, it was 71. Nine patients reported being very satisfied, one was moderately satisfied, and one was dissatisfied.
Conclusion: The involvement of adjacent joints is very frequent in the long term, but this does not have a direct impact on the patient’s functional outcomes.
Objective: To determine the involvement of adjacent joints in the medium and long term and its impact on functional outcomes in patients with ankle arthrodesis.
Materials and Methods: We evaluated a series of 11 patients, 6 females and 5 males. The initial diagnosis was post-traumatic osteoarthritis (9 cases), septic arthritis (1 case), and osteochondral lesion of the talus (1 case). The mean age at the time of surgery was 50 years. The mean follow-up was 9 years. The radiographic compromise of the adjacent joints was evaluated. The patients were functionally evaluated using the Visual Analog Pain Scale (VAS), the AOFAS scale (American Orthopedic Foot and Ankle Score), and a simple satisfaction questionnaire.
Results: 10 patients (91%) presented with osteoarthritis of one of the adjacent joints. The average score on the VAS was 2.6, while on the AOFAS scale, it was 71. Nine patients reported being very satisfied, one was moderately satisfied, and one was dissatisfied.
Conclusion: The involvement of adjacent joints is very frequent in the long term, but this does not have a direct impact on the patient’s functional outcomes.
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How to Cite
Macklin Vadell , A., Sperone , E., Bigatti, A., Iglesias , M., Atilmis, Y., Rofrano, M., Cruz, S., & Fedún Rodríguez, E. (2024). Compromise of Adjacent Joints in Long-Term Evolution of Ankle Arthrodesis. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(2), 113-120. https://doi.org/10.15417/issn.1852-7434.2024.89.2.1804
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Clinical Research
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References
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osteoarthritis. Int Orthop 2020;44(3):535-43. https://doi.org/10.1007/s00264-019-04476-x
4. Giuseppe Usuelli F, Manzi L. Inframalleolar varus deformity role of calcaneal osteotomies. Foot Ankle Clin
2019;24(2):219-37. https://doi.org/10.1016/j.fcl.2019.02.011
5. Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, Nalysnyk L. Intermediate and long-term outcomes
of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am
2007;89(9):1899-905. https://doi.org/10.2106/JBJS.F.01149
6. Onggoa JR, Nambiara M, Phanc K, Hickeya B, Galvina M, Bedia H. Outcome after total ankle arthroplasty with
a minimum of five years follow-up: A systematic review and meta-analysis. Foot Ankle Surg 2020;26(5):556-63.
https://doi.org/10.1016/j.fas.2019.07.006
7. Hintermann B, Valderrabano V. Total ankle replacement. Foot Ankle Clin North Am 2003;8:375-405.
https://doi.org/10.1016/s1083-7515(03)00015-9
8. Houdek MT, Wilke BK, Ryssman DB, Turner NS. Radiographic and functional outcomes following bilateral ankle
fusions. Foot Ankle Int 2014;35(12):1250-4. https://doi.org/10.1177/1071100714551947
9. Ferkel RD, Hewitt M. Long-term results of arthroscopic ankle arthrodesis. Foot Ankle Int 2005;26(4):275-80.
https://doi.org/10.1177/107110070502600402
10. Coester LM, Saltzman CL, Leupold J, Pontarelli W. Long term results following ankle arthrodesis for posttraumatic arthritis. J Bone Joint Surg Am 2001;83(2):219-28. https://doi.org/10.2106/00004623-200102000-00009
11. Hendrickx RPM, Stufkens SAS, Bruijn EE, Sierevelt IN, van Dijk CN, Kerkhoffs GMMJ. Medium- to long-term
outcome of ankle arthrodesis. Foot Ankle Int 2011;32(10):940-7. https://doi.org/10.3113/FAI.2011.0940
12. Kellgren JH, Moore R. Generalized osteoarthritis and Heberden’s nodes. Br Med J 1952;1(4751):181-7.
https://doi.org/10.1136/bmj.1.4751.181
13. Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg
Am 1979;61:964-75. PMID: 489661
14. Morgan CD, Henke JA, Bailey RW, Kaufer H. Long-term results of tibiotalar arthrodesis. J Bone Joint Surg Am
1985;67:546-9. PMID: 3980499
15. Hallock H. Arthrodesis of the ankle joint for old, painful fractures. J Bone Joint Surg Am 1945;27:49-58. Disponible en: https://journals.lww.com/jbjsjournal/Citation/1945/27010/ARTHRODESIS_OF_THE_ANKLE_JOINT_FOR_
OLD_PAINFUL.5.aspx/ [Consulta: febrero 2023].
16. Winson IG, Robinson DE, Allen PE. Arthroscopic ankle arthrodesis. J Bone Joint Surg Br 2005;87(3):343-7.
https://doi.org/10.1302/0301-620x.87b3.15756.
17. Smith R, Wood PLR. Arthrodesis of the ankle in the presence of a large deformity in the coronal plane. J Bone Joint Surg Br 2007;89(5):615-9. https://doi.org/10.1302/0301-620X.89B5.18109
18. Hartmann R, Grubhofer F, Waibel FWA, Götschi T, Viehöfer AF, Wirth SH. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis. J Orthop Res 2021;39(10):2151-8. https://doi.org/10.1002/jor.24938
19. Kennedy JG, Hodgkins CW, Brodsky A, Bohne WH. Outcomes after standardized screw fixation technique of ankle arthrodesis. Clin Orthop Relat Res 2006;447:112-8. https://doi.org/10.1097/01.blo.0000203480.04174.0e
20. Kerkhoff YRA, Keijsers NLW, Louwerens JWK. Sports participation, functional outcome, and complications after ankle arthrodesis: Midterm follow-up. Foot Ankle Int 2017;38(10):1085-91. https://doi.org/10.1177/1071100717717221
21. Said E, Hunka L, Siller TN. Where ankle fusion stands today. J Bone Joint Surg Br 1978;60:211-4.
https://doi.org/10.1302/0301-620X.60B2.659467
22. Jackson A, Glasgow M. Tarsal hypermobility after ankle fusion—fact or fiction? J Bone Joint Surg Br 1979;61:470-3. https://doi.org/10.1302/0301-620X.61B4.500759
23. Vier D, Irwin TA. Open ankle arthrodesis for deformity correction. Foot Ankle Clin 2022;27(1):199-216.
https://doi.org/10.1016/j.fcl.2021.11.009
24. E Manke, N Yeo Eng Meng, S Rammelt. Ankle arthrodesis - A review of current techniques and results. Acta Chir Orthop Traumatol Cech 2020;87(4):225-36. PMID: 32940217
osteotomies. Foot Ankle Clin 2019;24(2):239-64. https://doi.org/10.1016/j.fcl.2019.02.004
2. Krähenbühl N, Akkaya M, Deforth M, Zwicky L, Barg A, Hintermann B. Extraarticular supramalleolar osteotomy in asymmetric varus ankle osteoarthritis. Foot Ankle Int 2019;40(8):936-47. https://doi.org/10.1177/1071100719845928
3. Krähenbühl N, Susdorf R, Barg A, Hintermann B. Supramalleolar osteotomy in post-traumatic valgus ankle
osteoarthritis. Int Orthop 2020;44(3):535-43. https://doi.org/10.1007/s00264-019-04476-x
4. Giuseppe Usuelli F, Manzi L. Inframalleolar varus deformity role of calcaneal osteotomies. Foot Ankle Clin
2019;24(2):219-37. https://doi.org/10.1016/j.fcl.2019.02.011
5. Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, Nalysnyk L. Intermediate and long-term outcomes
of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am
2007;89(9):1899-905. https://doi.org/10.2106/JBJS.F.01149
6. Onggoa JR, Nambiara M, Phanc K, Hickeya B, Galvina M, Bedia H. Outcome after total ankle arthroplasty with
a minimum of five years follow-up: A systematic review and meta-analysis. Foot Ankle Surg 2020;26(5):556-63.
https://doi.org/10.1016/j.fas.2019.07.006
7. Hintermann B, Valderrabano V. Total ankle replacement. Foot Ankle Clin North Am 2003;8:375-405.
https://doi.org/10.1016/s1083-7515(03)00015-9
8. Houdek MT, Wilke BK, Ryssman DB, Turner NS. Radiographic and functional outcomes following bilateral ankle
fusions. Foot Ankle Int 2014;35(12):1250-4. https://doi.org/10.1177/1071100714551947
9. Ferkel RD, Hewitt M. Long-term results of arthroscopic ankle arthrodesis. Foot Ankle Int 2005;26(4):275-80.
https://doi.org/10.1177/107110070502600402
10. Coester LM, Saltzman CL, Leupold J, Pontarelli W. Long term results following ankle arthrodesis for posttraumatic arthritis. J Bone Joint Surg Am 2001;83(2):219-28. https://doi.org/10.2106/00004623-200102000-00009
11. Hendrickx RPM, Stufkens SAS, Bruijn EE, Sierevelt IN, van Dijk CN, Kerkhoffs GMMJ. Medium- to long-term
outcome of ankle arthrodesis. Foot Ankle Int 2011;32(10):940-7. https://doi.org/10.3113/FAI.2011.0940
12. Kellgren JH, Moore R. Generalized osteoarthritis and Heberden’s nodes. Br Med J 1952;1(4751):181-7.
https://doi.org/10.1136/bmj.1.4751.181
13. Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg
Am 1979;61:964-75. PMID: 489661
14. Morgan CD, Henke JA, Bailey RW, Kaufer H. Long-term results of tibiotalar arthrodesis. J Bone Joint Surg Am
1985;67:546-9. PMID: 3980499
15. Hallock H. Arthrodesis of the ankle joint for old, painful fractures. J Bone Joint Surg Am 1945;27:49-58. Disponible en: https://journals.lww.com/jbjsjournal/Citation/1945/27010/ARTHRODESIS_OF_THE_ANKLE_JOINT_FOR_
OLD_PAINFUL.5.aspx/ [Consulta: febrero 2023].
16. Winson IG, Robinson DE, Allen PE. Arthroscopic ankle arthrodesis. J Bone Joint Surg Br 2005;87(3):343-7.
https://doi.org/10.1302/0301-620x.87b3.15756.
17. Smith R, Wood PLR. Arthrodesis of the ankle in the presence of a large deformity in the coronal plane. J Bone Joint Surg Br 2007;89(5):615-9. https://doi.org/10.1302/0301-620X.89B5.18109
18. Hartmann R, Grubhofer F, Waibel FWA, Götschi T, Viehöfer AF, Wirth SH. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis. J Orthop Res 2021;39(10):2151-8. https://doi.org/10.1002/jor.24938
19. Kennedy JG, Hodgkins CW, Brodsky A, Bohne WH. Outcomes after standardized screw fixation technique of ankle arthrodesis. Clin Orthop Relat Res 2006;447:112-8. https://doi.org/10.1097/01.blo.0000203480.04174.0e
20. Kerkhoff YRA, Keijsers NLW, Louwerens JWK. Sports participation, functional outcome, and complications after ankle arthrodesis: Midterm follow-up. Foot Ankle Int 2017;38(10):1085-91. https://doi.org/10.1177/1071100717717221
21. Said E, Hunka L, Siller TN. Where ankle fusion stands today. J Bone Joint Surg Br 1978;60:211-4.
https://doi.org/10.1302/0301-620X.60B2.659467
22. Jackson A, Glasgow M. Tarsal hypermobility after ankle fusion—fact or fiction? J Bone Joint Surg Br 1979;61:470-3. https://doi.org/10.1302/0301-620X.61B4.500759
23. Vier D, Irwin TA. Open ankle arthrodesis for deformity correction. Foot Ankle Clin 2022;27(1):199-216.
https://doi.org/10.1016/j.fcl.2021.11.009
24. E Manke, N Yeo Eng Meng, S Rammelt. Ankle arthrodesis - A review of current techniques and results. Acta Chir Orthop Traumatol Cech 2020;87(4):225-36. PMID: 32940217