Re-arthrodesis after primary ankle fusion: 134/1,716 cases from the Swedish Ankle Registry

Abstract

Background and purpose — Arthrodesis is the most common treatment of severe ankle arthritis. Large studies on the occurrence of re-arthrodesis are few, especially with information in terms of risk. We used the National Swedish Ankle Registry to assess incidence and risk factors for re-arthrodesis.Patients and methods — In the Registry, we examined the occurrence of re-arthrodesis in 1,716 patients with a primary ankle arthrodesis. We also analyzed associations between the re-arthrodesis risk and sex, diagnosis, and surgical method.Results — The risk of first re-arthrodesis at 2.5 years was 7.4% and the rate at 9 years 7.8%. The risk following arthroscopic surgery with fixation by screws was 15%, which is statistically significantly higher than the 8% following the gold standard technique with open screw fixation, the 5% following fixation by intramedullary nailing, and the 3% following fixation by plate and screws. Patients with either idiopathic osteoarthritis or posttraumatic arthritis had a higher risk of re-arthrodesis than patients with rheumatoid arthritis. We could not find that the risk of re-arthrodesis was associated with sex.Interpretation — In Sweden, the re-arthrodesis risk varied by primary technique and was especially high after arthroscopic surgery. Reasons are unknown but poor surgical technique and/or surgeon inexperience may contribute, as may patient selection.

Pre-Planning Ankle Arthrodesis Using 3d Reconstructed Tomographies

“…High non-consolidation rates reported in all types of fixation make this an important issue. 7,8,15 Many studies focus on the biomechanical stability of different fixation methods 11 ; however, they do not mention how to find the best entry point and the entry angle for the screw, which increases the need for experience and skill of the surgeon, increasing the chance of error. The best positioning and the quantity of screws are still controversial.…”

“…3,6,7 A third screw was generally added to the anteroposterior axis due to the high incidence of non-consolidations, usually with posterolateral entry into the tibia towards the neck of the talus, known as "home-run" screw ( Figures 1 and 2). [7][8][9][10] The screw is positioned to confront the strong deformation force of the Achilles tendon. [11][12][13] The stability of arthrodesis made only with the screws seems to be sufficient.…”

“…5,11 But plates are often used to neutralize rotation forces along the screws. 9,14,15 Additional stability increased consolidation rates; 8 however, plates cannot be used in some cases as in arthroscopic arthrodesis. Most parameters used to determine surgery with good alignment and good position of screws use postoperative radiographs with load.…”

Takedown of Ankle Fusions and Conversion to Total Ankle Replacements

“…Ankle fusions are generally well tolerated, but may result in functional deficits such as adjacent joint arthritis, altered mechanics and gait, subsequent activity limitations, painful nonunion, and malalignment. 4,9,13,16,[21][22][23]27,30 Following tibiotalar fusion, abnormal load placed on surrounding joints results in higher rates of adjacent joint arthritis. 1,2,6,8 Initially patients could gain motion through the talonavicular (TN) and subtalar (ST) joints after ankle fusions, but it is incongruent movement that could lead to progressive degenerative joint disease (DJD).…”