Ankle arthrodesis is indicated as a primary surgical treatment option for disabling end-stage ankle osteoarthritis. In a review of Medicare patients from 2005 to 2014, a total of 19,120 ankle fusions were performed.¹ Fusion rates for ankle arthrodesis have been reported between 80% to 100%, depending on technique and indication.²,³,⁴,⁵ Complication rates ranging between 0% and 50% have been reported with any of the described techniques, including infection, wound dehiscence, nonunion, and painful hardware.⁵,⁶

Percutaneous fusion is an uncommonly employed technique consisting of joint preparation through two 3-mm portals, without the use of arthroscopy. As such, the literature on percutaneous fusion remains limited. In an early study by Lauge-Pedersen, percutaneous ankle fusion was performed in 10 patients with end-stage ankle rheumatoid arthritis. Ankle fusion was observed in all patients with a 100% patient satisfaction rate.⁷ More recently, a comparison of minimally invasive percutaneous joint preparation versus open techniques in a cadaver model was reported in the literature. Zhao et al. compared the percentage of joint surface preparation in various foot/ankle joints in a cadaveric model using percutaneous and open techniques. No significant differences were noted except for the talonavicular and calcaneocuboid joints where the percutaneous method prepared more of the joint surface. Of interest, more of the tibiotalar joint surface was able to be prepared percutaneously but not to a statistically significant difference.⁸

Patients typically complain of pain at the ankle joint, which most commonly affects the anterior aspect of the joint. Many patients will also complain of limited ankle range of motion. On clinical examination, patients will complain of tenderness to palpation at or around the ankle joint and can present with decreased range of motion. Individuals with certain deformities might also present with objective or subjective gross ankle instability.

Weight-bearing three-view foot and ankle radiographs are usually sufficient to diagnose and study the ankle. However, CT and MRI may be indicated in less clear situations such as deformities, avascular necrosis, fractures, Charcot’s, and other complex etiologies.