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Post-traumatic Ankle Arthritis: Fusions

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Evaluation and Surgical Management of the Ankle
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Abstract

Post-traumatic ankle arthritis is a common cause of pain and disability in patients who have sustained fractures or instability events. Unlike hip and knee arthritis, the biology of ankle arthritis is less commonly purely degenerative. The treatment of this condition varies based on patient presentation, etiology, and surgeon experience. Arthrodesis is the gold standard treatment for this condition, and multiple options are available to the treating surgeon regarding approach, implant selection, and concomitant procedures. There are some basic techniques that should be known to all foot and ankle surgeons, as well as some special considerations for particularly challenging cases and revision options.

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References

  1. Huch K, Kuettner KE, Dieppe P. Osteoarthritis in ankle and knee joints. Semin Arthritis Rheum. 1997;26:667–74.

    Article  CAS  PubMed  Google Scholar 

  2. Muehleman C, Bareither D, Huch K, Cole AA, Kuettner KE. Prevalence of degenerative morphological changes in the joints of the lower extremity. Osteoarthr Cartil. 1997;5:23–37.

    Article  CAS  Google Scholar 

  3. Kempson GE. Age-related changes in the tensile properties of human articular cartilage: a comparative study between the femoral head of the hip joint and the talus of the ankle joint. Biochim Biophys Acta. 1991;1075:223–30.

    Article  CAS  PubMed  Google Scholar 

  4. Athanasiou KA, Niederauer GG, Schenck RC. Biomechanical topography of human ankle cartilage. Ann Biomed Eng. 1995;23:697–704.

    Article  CAS  PubMed  Google Scholar 

  5. Saltzman CL, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005;25:44–6.

    PubMed  PubMed Central  Google Scholar 

  6. Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009;467:1800–6.

    Article  PubMed  Google Scholar 

  7. Deleu PA, et al. Post-sprain versus post-fracture post-traumatic ankle osteoarthritis: impact on foot and ankle kinematics and kinetics. Gait Posture. 2021;86:278–86.

    Article  PubMed  Google Scholar 

  8. Seaworth CM, et al. Epidemiology of total ankle arthroplasty: trends in New York State. Orthopedics. 2016;39:170–6.

    Article  PubMed  Google Scholar 

  9. Sturnick DR, et al. Adjacent joint kinematics after ankle arthrodesis during cadaveric gait simulation. Foot Ankle Int. 2017;38:1249–59.

    Article  PubMed  Google Scholar 

  10. Ling JS, et al. Investigating the relationship between ankle arthrodesis and adjacent-joint arthritis in the hindfoot: a systematic review. J Bone Joint Surg Am. 2015;97:513–9.

    Article  PubMed  Google Scholar 

  11. Kuettner KE, Cole AA. Cartilage degeneration in different human joints. Osteoarthr Cartil. 2005;13:93–103.

    Article  CAS  Google Scholar 

  12. Adams SB, et al. Inflammatory cytokines and matrix metalloproteinases in the synovial fluid after intra-articular ankle fracture. Foot Ankle Int. 2015;36:1264–71.

    Article  PubMed  Google Scholar 

  13. Adams SB, et al. Inflammatory microenvironment persists after bone healing in intra-articular ankle fractures. Foot Ankle Int. 2017;38:479–84.

    Article  PubMed  Google Scholar 

  14. Furman BD, et al. Articular ankle fracture results in increased synovitis, synovial macrophage infiltration, and synovial fluid concentrations of inflammatory cytokines and chemokines. Arthritis Rheumatol. 2015;67:1234–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Pham TM, et al. Association of acute inflammatory cytokines, fracture malreduction, and functional outcome 12 months after intra-articular ankle fracture-a prospective cohort study of 46 patients with ankle fractures. J Orthop Surg Res. 2021;16:338.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Allport J, Ramaskandhan J, Siddique MS. Nonunion rates in hind- and midfoot arthrodesis in current, ex-, and nonsmokers. Foot Ankle Int. 2021;42:582–8.

    Article  PubMed  Google Scholar 

  17. Barg A, et al. Weightbearing computed tomography of the foot and ankle: emerging technology topical review. Foot Ankle Int. 2018;39:376–86.

    Article  PubMed  Google Scholar 

  18. Richter M, Seidl B, Zech S, Hahn S. PedCAT for 3D-imaging in standing position allows for more accurate bone position (angle) measurement than radiographs or CT. Foot Ankle Surg. 2014;20:201–7.

    Article  PubMed  Google Scholar 

  19. 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;27:339–47.

    Article  PubMed  Google Scholar 

  20. Chalayon O, et al. Factors affecting the outcomes of uncomplicated primary open ankle arthrodesis. Foot Ankle Int. 2015;36:1170–9.

    Article  PubMed  Google Scholar 

  21. Tarkin IS, et al. Anterior plate supplementation increases ankle arthrodesis construct rigidity. Foot Ankle Int. 2007;28:219–23.

    Article  PubMed  Google Scholar 

  22. Kestner CJ, Glisson RR, Nunley JA. A biomechanical analysis of two anterior ankle arthrodesis systems. Foot Ankle Int. 2013;34:1006–11.

    Article  PubMed  Google Scholar 

  23. Plaass C, Knupp M, Barg A, Hintermann B. Anterior double plating for rigid fixation of isolated tibiotalar arthrodesis. Foot Ankle Int. 2009;30:631–9.

    Article  PubMed  Google Scholar 

  24. Chinnakkannu K, et al. Mini-open vs. transfibular approach for ankle arthrodesis, which approach is superior in joint preparation: a cadaver study. Indian J Orthop. 2020;55:135–41.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Paremain GD, Miller SD, Myerson MS. Ankle arthrodesis: results after the miniarthrotomy technique. Foot Ankle Int. 1996;17:247–52.

    Article  CAS  PubMed  Google Scholar 

  26. Mann RA, Van Manen JW, Wapner K, Martin J. Ankle fusion. Clin Orthop Relat Res. 1991;(268):49–55.

    Google Scholar 

  27. Smith JT, Chiodo CP, Singh SK, Wilson MG. Open ankle arthrodesis with a fibular-sparing technique. Foot Ankle Int. 2013;34:557–62.

    Article  PubMed  Google Scholar 

  28. Ciufo DJ, Grant AM. Orthogonal locked plating for tibiotalocalcaneal arthrodesis. Tech Foot Ankle Surg. 2022;21(1):40–7. https://doi.org/10.1097/BTF.0000000000000295.

  29. Kim JG, et al. Ankle arthrodesis: a comparison of anterior approach and transfibular approach. Clin Orthop Surg. 2018;10:368–73.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mulligan RP, Adams SB, Easley ME, DeOrio JK, Nunley JA. Comparison of posterior approach with intramedullary nailing versus lateral transfibular approach with fixed-angle plating for tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2017;38:1343–51.

    Article  PubMed  Google Scholar 

  31. Kile TA, Donnelly RE, Gehrke JC, Werner ME, Johnson KA. Tibiotalocalcaneal arthrodesis with an intramedullary device. Foot Ankle Int. 1994;15:669–73.

    Article  CAS  PubMed  Google Scholar 

  32. Nickisch F, Avilucea FR, Beals T, Saltzman C. Open posterior approach for tibiotalar arthrodesis. Foot Ankle Clin. 2011;16:103–14.

    Article  PubMed  Google Scholar 

  33. Pellegrini MJ, et al. Outcomes of tibiotalocalcaneal arthrodesis through a posterior achilles tendon-splitting approach. Foot Ankle Int. 2016;37:312–9.

    Article  PubMed  Google Scholar 

  34. Fetter NL, DeOrio JK. Posterior approach with fibular preservation for tibiotalocalcaneal arthrodesis with an intramedullary nail. Foot Ankle Int. 2012;33:746–9.

    Article  PubMed  Google Scholar 

  35. Quayle J, et al. Arthroscopic versus open ankle arthrodesis. Foot Ankle Surg. 2018;24:137–42.

    Article  PubMed  Google Scholar 

  36. Ferkel RD, Hewitt M. Long-term results of arthroscopic ankle arthrodesis. Foot Ankle Int. 2005;26:275–80.

    Article  PubMed  Google Scholar 

  37. Myerson MS, Quill G. Ankle arthrodesis: a comparison of an arthroscopic and an open method of treatment. Clin Orthop Relat Res. 1991;(268):84–95.

    Google Scholar 

  38. Kendal AR, Cooke P, Sharp R. Arthroscopic ankle fusion for avascular necrosis of the talus. Foot Ankle Int. 2015;36:591–7.

    Article  PubMed  Google Scholar 

  39. Dannawi Z, Nawabi DH, Patel A, Leong JJH, Moore DJ. Arthroscopic ankle arthrodesis: are results reproducible irrespective of pre-operative deformity? Foot Ankle Surg. 2011;17:294–9.

    Article  CAS  PubMed  Google Scholar 

  40. Morasiewicz P, et al. Radiological evaluation of ankle arthrodesis with Ilizarov fixation compared to internal fixation. Injury. 2017;48:1678–83.

    Article  PubMed  Google Scholar 

  41. Jones CP, Youngblood SA, Waldrop N, Davis WH, Pinzur MS. Tibial stress fracture secondary to half-pins in circular ring external fixation for charcot foot. Foot Ankle Int. 2014;35:572–7.

    Article  PubMed  Google Scholar 

  42. Paley D, Lamm BM, Katsenis D, Bhave A, Herzenberg JE. Treatment of malunion and nonunion at the site of an ankle fusion with the Ilizarov apparatus. J Bone Joint Surg. 2006;88:119–34.

    PubMed  Google Scholar 

  43. Paley D. Principles of deformity correction. Berlin: Springer; 2002. https://doi.org/10.1007/978-3-642-59,373-4.

    Book  Google Scholar 

  44. Paley D, Chaudray M, Pirone AM, Lentz P, Kautz D. Treatment of malunions and mal-nonunions of the femur and tibia by detailed preoperative planning and the Ilizarov techniques. Orthop Clin North Am. 1990;21:667–91.

    Article  CAS  PubMed  Google Scholar 

  45. Conway JD. Charcot salvage of the foot and ankle using external fixation. Foot Ankle Clin. 2008;13:157–73.

    Article  PubMed  Google Scholar 

  46. Lee DJ, Schaffer J, Chen T, Oh I. Internal versus external fixation of charcot midfoot deformity realignment. Orthopedics. 2016;39:e595–601.

    Article  PubMed  Google Scholar 

  47. Lovisetti G, Kirienko A, Myerson C, Vulcano E. Ankle salvage following nonunion of distal tibia fractures. Foot Ankle Int. 2018;39:1210–8.

    Article  PubMed  Google Scholar 

  48. Wang B, Saltzman CL, Chalayon O, Barg A. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res. 2015;473:318–25.

    Article  PubMed  Google Scholar 

  49. AlSayel F, Valderrabano V. Arthrodesis of a varus ankle. Foot Ankle Clin. 2019;24:265–80.

    Article  PubMed  Google Scholar 

  50. Fortin P, Guettler J, Manoli AR, Oak MI. Idiopathic cavovarus and lateral ankle instability: recognition and treatment implications relating to ankle arthritis. Foot Ankle Int. 2002.

    Google Scholar 

  51. Krähenbühl N, Susdorf R, Barg A, Hintermann B. Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis. Int Orthop. 2020;44:535–43.

    Article  PubMed  Google Scholar 

  52. Choi JY, Kim KW, Suh JS. Low tibial valgization osteotomy for more severe varus ankle arthritis. Foot Ankle Int. 2020;41:1122–32.

    Article  PubMed  Google Scholar 

  53. Goodier WD, Calder PR. External fixation for the correction of adult post-traumatic deformities. Injury. 2019;50:S36–44.

    Article  PubMed  Google Scholar 

  54. Hegeman E, Dowd TC, Huh J. Outcomes following intramedullary nail vs plate fixation for tibiotalocalcaneal arthrodesis: a systematic review. Foot Ankle Orthop. 2022;7:2473011421S00230.

    Article  PubMed Central  Google Scholar 

  55. Jeng CL, Campbell JT, Tang EY, Cerrato RA, Myerson MS. Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 2013;34:1256–66.

    Article  PubMed  Google Scholar 

  56. Heidari KS, Lalli T. Case report: tibiotalocalcaneal arthrodesis utilizing a titanium mesh implant for limb salvage after failed charcot reconstruction. Foot Ankle Orthop. 2022;7:2473011421S00231.

    Article  PubMed Central  Google Scholar 

  57. Steele JR, et al. Comparison of 3D printed spherical implants versus femoral head allografts for tibiotalocalcaneal arthrodesis. J Foot Ankle Surg. 2020;59:1167–70.

    Article  PubMed  Google Scholar 

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Ciufo, D.J., Fortin, P.T. (2023). Post-traumatic Ankle Arthritis: Fusions. In: Herscovici Jr., D., Anglen, J.O., Early, J.S. (eds) Evaluation and Surgical Management of the Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-33537-2_21

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  • DOI: https://doi.org/10.1007/978-3-031-33537-2_21

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