Outcome of arthrodesis of the hindfoot as a salvage procedure for complex ankle pathology using the Ilizarov technique

Abstract

Achieving arthrodesis of the ankle can be difficult in the presence of infection, deformity, poor soft tissues and bone loss. We present a series of 48 patients with complex ankle pathology, treated with the Ilizarov technique. Infection was present in 30 patients and 30 had significant deformity before surgery. Outcome was assessed clinically and with patient-reported outcome measures (Modified American Orthopaedic Foot and Ankle Society (MAOFAS) scale and the Short-Form (SF-36)). Arthrodesis was achieved in 40 patients with the Ilizarov technique alone and in six further patients with additional surgery. Infection was eradicated in all patients at a mean follow-up of 46.6 months (13 to 162). Successful arthrodesis was less likely in those with comorbidities and in tibiocalcaneal fusion compared with tibiotalar fusion. These patients had poor general health scores compared with the normal population before surgery. The mean MAOFAS score improved significantly from 24.3 (0 to 90) pre-operatively to 56.2 (30 to 90) post-operatively, but there was only a modest improvement in general health; the mean SF-36 improved from 44.8 (19 to 66) to 50.1 (21 to 76). There was a major benefit in terms of pain relief. Arthrodesis using the Ilizarov technique is an effective treatment for complex ankle pathology, with good clinical outcomes and eradication of infection. However, even after successful arthrodesis general health scores remain limited.

Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients

“…Our study is in line with the existing literature (i.e., Rochmann et al) reporting worse results than studies analyzing patients with tibiotalar arthrodesis [5,6,9,10,12]. Kugan et al also described a higher failure rate after loss of the talus in his study [13]. The calculated modified AOFAS score (max 86 points) was 53 points on average (min 25; max 68) in seven patients in this study, which is below the reported score of 65 points (eleven patients) in the study by Rochmann et al [12].…”

“…Since the introduction of compression arthrodesis by Charney in 1951, several different surgical procedures have been described as treatment options for ankle destruction of various etiologies [1]. Today, external Ilizarov arthrodesis represents an established and effective procedure in compromised hosts with acute or chronic infections, soft tissue defects, axial malpositions (varus/valgus) and comorbidities (diabetes mellitus, polyneuropathy, peripheral vascular disease, and alcohol abuse) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Some authors even consider the Ilizarov method to be the "gold standard" in these difficult situations [2].…”

“…However, in patients with severe talus destruction due to infection or necrosis, talectomy might be required. In these patients, tibiocalcaneal arthrodesis is necessary to potentially achieve a painless stable limb [2,3,7,8,[12][13][14][15][16][17][18]. However, only a few studies in the literature described tibiocalcaneal arthrodesis using the Ilizarov fixator.…”

Outcome of Ilizarov assisted ankle arthrodesis

“…Several studies report a statistically significant difference between the preoperative and postoperative AOFAS Scores by the use of Ilizarov fixator. [12][13][14] The average postoperative shortening was found to be 2.62cm in present study. Simultaneously proceeded with tibial lengthening along with ankle arthrodesis.…”

Ilizarov external fixation versus plate internal fixation in the treatment of end-stage ankle arthritis: decision analysis of clinical parameters

“…Kugan et al . 28 achieved an 83% fusion rate with satisfying functional improvement and no recurrence of previous deep infection in 48 patients with multiple comorbidities using the Ilizarov technique alone. Despite a few expected complications, most of which can be cured with early detection, IEF serves as a reasonable limb salvage alternative to amputation in this subset of patients 29 .…”