Ankle Arthrodesis

Last Updated on November 16, 2018

Ankle arthrodesis is performed more commonly than that of the hip or knee. It is also called ankle fusion.

Most common indication for performing this surgery is arthritis following an injury to ankle also called post-traumatic arthritis.

Other indications are

Rheumatoid arthritis
Infection
Neuromuscular disorders
Failed total ankle arthroplasty.
Bone tumors around the ankle

Before proceeding with arthrodesis, the surgeon might give you a below-knee cast to see if you are a suitable candidate for arthrodesis.

Ankle Arthrodesis — Image credit: Radiopaedia

Position

The optimal position for ankle fusion is

0 degrees of flexion
0 to 5 degrees of valgus
5 to 10 degrees of external rotation with a slight posterior displacement of the talus.

Approaches of Ankle Arthrodesis

Access for ankle arthrodesis can be anterior, transmalleolar and posterior.

The ankle is approached from the anterior [front] side with or without an additional small incision.

Transmalleolar

This approach provides slightly better access to the posterior aspect of the ankle joint. Exposure is improved by medial and lateral transmalleolar osteotomies.

Posterior

The posterior approach can be used in patients with compromised anterior skin from previous trauma or surgery.

Fixation in Ankle Arthrodesis

Depending on the fixation method used, the techniques of ankle arthrodesis can be classified as –

External fixation

Charnley fixation clamp
Calandruccio compression device
Ring Fixator
Tubular external fixators

Internal Fixation

Internal fixation has several theoretical advantages over external fixation.

Ease of insertion
Patient convenience
Comparable rates of delayed union, malunion, nonunion, and infection
Greater resistance to shear stress.

Following modalities are used in internal fixation

Cancellous screws – parallel or crossed
Direct compression plates
Kirschner wires
Steinmann pins
Intramedullary rods
Lateral T-plate
Posterior blade plate fixation.

Procedure of Ankle Arthrodesis

The procedure involves denuding the remaining articular cartilage and making two parallel cuts, one through the distal tibia and one through the dome of talus to resect a minimal amount of bone to allow apposition of large cancellous surfaces and translation of the talus posteriorly beneath the tibia.

Addition of bone grafting is said to increase the fusion rate. Bone graft can be taken from tibia or either lateral or medial malleolus.

Arthroscopic Ankle Arthrodesis

Arthroscopically assisted ankle arthrodesis offers advantages of

Quicker fusion because of the limited exposure and less extensive periosteal stripping
Preservation of the overall contour of the ankle mortise, giving a better cosmetic result.

Prognosis of Ankle Arthrodesis

In general overall shortening generally is less than 1 cm and fusion rate is 80% to 90%.

Arthrodesis offers good pain relief but there is limited hindfoot motion which can result in difficult walking on uneven surfaces.

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About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

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