Revision of the Malaligned Ankle Arthrodesis

Reeves, Christopher L.; Shane, Amber M.; Sahli, Hannah; Togher, Cody J.

doi:10.1016/j.cpm.2020.03.003

Cited by 4 publications

(5 citation statements)

References 38 publications

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“…Complications of ankle fusion malalignment are well known, but the impact on a subtalar arthrodesis has not been studied to date. 27 Again, because of our small sample size in this study we were not able to draw any conclusions on the effect of the tibiotalar angle on subtalar fusion.…”

Section: Discussionmentioning

confidence: 76%

Subtalar Arthrodesis in Patients With Prior Tibiotalar Arthrodesis for Posttraumatic Osteoarthritis

Theunissen

Birch

Reymond³

et al. 2023

Foot Ankle Int.

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Background: The tibiotalar arthrodesis for end-stage ankle osteoarthritis is a surgical procedure that leads to a modification of the kinematics of the adjacent joints and may result in the development of secondary osteoarthritic degeneration of the subtalar joint. It has previously been observed that subtalar arthrodesis in this context shows a lower fusion rate than isolated subtalar arthrodesis. This retrospective study reports the results of subtalar joint arthrodesis with previous ipsilateral tibiotalar arthrodesis and suggests some factors that may compromise the fusion of the joint. Methods: Between September 2010 and October 2021, 15 arthrodeses of the subtalar joint with screw fixation were performed in 14 patients, with a fusion of the ipsilateral tibiotalar joint. Fourteen of 15 cases used an open sinus tarsi approach, 13 were augmented with iliac crest bone graft, and 11 had supplemental demineralized bone matrix (DBM). The outcome variables were fusion rate, time to fusion, and revision rate. Fusion was assessed by radiographs and computed tomography scan. Results: Twelve of the 15 subtalar arthrodeses (80%) fused at the first attempt with an average fusion time of 4.7 months. Conclusion: In this limited retrospective case series, compared to the fusion rate of isolated subtalar arthrodesis reported in the literature, the rate of subtalar fusion in the presence of an ipsilateral tibiotalar arthrodesis was found to be lower. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 76%

Subtalar Arthrodesis in Patients With Prior Tibiotalar Arthrodesis for Posttraumatic Osteoarthritis

Theunissen

Birch

Reymond³

et al. 2023

Foot Ankle Int.

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“…Use of an external fixator with subsequent removal is another possible element especially in a posttraumatic setting. 27,28 Adjacent joint fusion was more prevalent in the AA cohort at each postoperative time interval. This result was also found by Stavrakis and colleagues who reported patients receiving TAR were less likely to receive subtalar fusion (hazard ratio [HR] 0.45; 95% CI, 0.24-0.83) after the index procedure.…”

Section: Discussionmentioning

confidence: 94%

“…Such intervention includes management of arthrodesis nonunion, which prior literature has estimated to occur in 12% of patients, 24 as well as augmentation of malaligned internal fixator constructs. 27 ORIF following either procedure could also reflect reduction of intraoperative (eg, medial malleolar fractures during TAR) or periprosthetic fractures. Higher rates of hardware removal following AA at 1 year (16.4% vs 6.9%) and 2 years (22.7% vs 10.1%) also aligns with prior studies.…”

Section: Discussionmentioning

confidence: 99%

Reoperation Rates Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Posttraumatic Indications

Ross

Savage-Elliott

et al. 2021

Foot & Ankle Specialist

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Aims: This studied aimed to compare rates of reoperation for patients who received primary ankle arthrodesis (AA) versus total ankle replacement (TAR) for posttraumatic indications between 2010 and 2016 Q2 using a nationwide claims database. Methods: A retrospective cohort study analyzing patients who received primary AA or TAR for posttraumatic indications was performed using PearlDiver. Reoperations assessed included prosthetic joint infection (PJI), hardware removal, adjacent joint fusion, and local open reduction internal fixation (ORIF). Multivariable logistic regression was used to compare rates of reoperations at 1 and 2 years postdischarge. Results: A total of 862 (74%) patients received AA and 318 (26%) patients underwent TAR for a posttraumatic indication. At 1 year, 305 (35.4%) AA patients had at least 1 reoperation compared with 55 (17.3%) TAR patients (OR 2.32; 95% CI, 1.68-3.26). At 2 years, 364 (42.2%) AA patients and 66 (20.8%) TAR patients had at least 1 reoperation (OR 2.51; 95% CI, 1.84-3.45). ORIF, hardware removal, and adjacent joint fusions were more likely for AA patients at both time intervals (all Ps < .05). Conclusion: Patients who received primary AA for posttraumatic indications exhibited higher rates of major reoperations in the short to medium term compared with patients who underwent TAR. Levels of Evidence: Level III: Retrospective cohort study

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“…Разработка тактики ревизионных оперативных вмешательств при нарушении формирования костного анкилоза голеностопного сустава после первичного артродезирования обладает высокой актуальностью в связи с наличием значительного количества неудовлетворительных исходов хирургического лечения, в том числе на фоне осложнений механического происхождения, связанных с ранее установленным фиксатором [11,13,16].…”

Section: Discussionunclassified

“…Основываясь на собственном клиническом опыте и литературных данных, мы делаем вывод о том, что все осложнения механического происхождения, потребовавшие проведения ревизионного оперативного вмешательства, можно объединить в 3 группы: асептическое расшатывание элементов металлоконструкции, усталостный перелом интрамедуллярного стержня, периимплантный перелом большеберцовой кости [13,14,16,17]. Резорбция костной ткани в зоне контакта с имплантатом таранной, пяточной и большеберцовой кости приводит к постепенной потере прочности фиксации и как следствие -к нарушению процессов консолидации и формированию костных дефектов [19,20].…”

Section: Discussionunclassified

Revision surgeries following ankle arthrodesis fixed with retrograde intramedullary nails affected by mechanical complications

Grazhdanov,

Zuev,

Kauts

et al. 2023

N.N. Priorov Journal of Traumatology and Orthopedics

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BACKGROUND: 25 percent of all musculoskeletal diseases that involve joints of the lower extremities accrues to ankle arthrosis. Late stages of this disease are indications for ankle arthrodesis. To date, surgeons who perform ankle arthrodesis do not agree about both the treatment technique for ankle articular surfaces and the method of their fixation, but other studies and our own observations suggest that 8 to 20 percent of the surgeries performed with retrograde locking rods lead to revision interventions due to the disorder of ankle ankylosis formation caused by mechanical complications associated with the implanted fixators (aseptic loosening of their parts, stress fracture of the intramedullary nail or locking screws, peri-implant tibia fracture). CLINICAL CASES DESCRIPTION: The aim of this work was to study and demonstrate the results of revision surgical interventions performed for failed ankylosis after ankle arthrodesis with intramedullary rod fixation against the development of mechanical complications. Clinical observations of revision interventions for failed ankylosis of the ankle joint against the complications due to mechanical origin using a retrograde blockable intramedullary rod as the primary fixator were carried out. Our work presents the technology of revision surgical interventions in case of compromised processes of ankle joint bone block formation associated with aseptic loosening of the structural elements, stress fracture of the intramedullary rod and blocking screws, tibial peri-implant fracture. CONCLUSION: Revision surgery for complications due to mechanical origin after ankle arthrodesis with intramedullary rod fixation requires an individual approach in each clinical case.

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Revision of the Malaligned Ankle Arthrodesis

Cited by 4 publications

References 38 publications

Subtalar Arthrodesis in Patients With Prior Tibiotalar Arthrodesis for Posttraumatic Osteoarthritis

Subtalar Arthrodesis in Patients With Prior Tibiotalar Arthrodesis for Posttraumatic Osteoarthritis

Reoperation Rates Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Posttraumatic Indications

Revision surgeries following ankle arthrodesis fixed with retrograde intramedullary nails affected by mechanical complications

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