(1)
Department of Orthopedic Surgery Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Abstract
This chapter describes the indications and operative technique for arthroscopic ankle arthrodesis. The results of arthroscopic ankle arthrodesis have been rewarding and favorable compared to open techniques. Also the long-term results which have been reported in the literature are rewarding in spite of arthritis and stiffness of adjacent joints. Indication for ankle fusion and ankle prosthesis is given.
The results of arthroscopic ankle arthrodesis are rewarding and favorable compared to open techniques.
Arthroscopic ankle fusion is an effective technique to achieve a stable tibiotalar arthrodesis, with a high rate of union and a low rate of complications.
A disadvantage of ankle arthrodesis is the decreased mobility which on the long term might induce arthritis and stiffness in adjacent joints.
11.1 Introduction
For end-stage arthritis, arthrodesis remains a good operative option. Open approaches to the ankle joint have been described and are numerous (Van Engelen et al. 2010). Open approaches have traditionally been related to a high number of complications like nonunion, delayed union, malunion, infection, wound necrosis, and neurovascular injury (Stone 2006).
Arthroscopic ankle fusion has shown to be an effective technique to achieve a stable tibiotalar arthrodesis, with a high rate of union and a low rate of complication (Table 11.1).
Table 11.1
Results of arthroscopic ankle arthrodesis
nr | % Good/excellent | % Nonunion | Weeks fusion | |
|---|---|---|---|---|
Morgan (1985) | 101 | 90 | 6 | |
Glick et al. (1996) | 34 | 96 | 4 | 9 |
Myerson (1991) | 33 | 0 | 9 | |
O’Brien (1999) | 36 | 5 | ||
French multicentre (1997) | 116 | 78 | 14 | |
Winson (2005) | 105 | 79 | 8 | |
aCannon et al. (2004) | 62 | 96 | 2 | |
Overall numbers | 487 | 78–96 | 0–14 | 9 |
11.2 Indications
The indications for arthroscopic ankle arthrodesis are the same as for open ankle arthrodesis. Conservative treatment includes physiotherapy, orthosis, NSAID treatment, and injections with hyaluronic acid (Witteveen et al. 2008; Chevalier et al. 2010). Indications for ankle arthrodesis include primary joint arthritis, end-stage rheumatoid arthritis, posttraumatic ankle joint deformity, crystalline arthritis, inflammatory arthropathy, postinfectious arthritis, large osteochondral lesions of the talar dome, and avascular necrosis (Table 11.2). The main contraindication for arthroscopic ankle arthrodesis is fixed varus or valgus alignment that precludes achievement of a neutral ankle position without significant bone resection from the talus or tibia. Relative contraindications for arthroscopic ankle arthrodesis are varus/valgus, malalignment more than 10°, malrotation, significant bone loss, and active infection (Hendrickx et al. 2011) (Fig. 11.1).
Table 11.2
summarizes the indication for arthroscopic arthrodesis, open ankle arthrodesis, or ankle prosthesis
Ankle fusion | Ankle prosthesis | |
|---|---|---|
Young | Elderly | |
High demand | Low demand | |
Good compensatory joints | Adjacent fusion
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