2017 ISAKOS Biennial Congress ePoster #152

 

Arthroscopic Arthrodesis For Ankle Arthritis Without Bone Graft

Xiajun Duan, MD, PhD, Chongqing CHINA
Department of Orthopedics, Southwest Hospital, Third Military Medical University, Chongqing, Chongqing, CHINA

FDA Status Cleared

Summary

Preparation of the joint surface with microfracture has been demonstrated to increase the union rate of arthroscopic ankle arthrodesis, while bone graft and other promoting substance are not necessary to be routinely used.

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Abstract

Background

Ankle arthrodesis is considered by many to be the standard operative treatment for end-stage ankle arthritis. The purpose of this study was to perform the new technique application for ankle joint surface and determine the outcome for the union rates of ankle arthroscopic arthrodesis.

Methods

A total of 68 patients with posttraumatic arthritis, primary osteoarthritis, and rheumatoid arthritis were treated by ankle arthroscopic arthrodesis between May 2007 and December 2012. Our surgical indication was deformity less than 15 °measured by weight-bearing radiographs. Firstly, the remaining articular cartilage was removed with different curettes and shavers. Then the new technique (microfracture) was done at tibiotalar surfaces. Finally the ankle was fixed with two cannulated percutaneous screws. The wound healing, complications, postoperative radiographs, and American Orthopaedic Foot and Ankle Society (AOFAS) score were evaluated.

Results

The average follow-up time was 32 months (range 25-58 months). No bone grafting and a fusion rate of 100% was achieved. The average fusion time was 12.1 weeks. One patient developed superficial infection at two weeks and it was cured by non- surgical treatment. No deep infections, deep venous thrombosis, or revision surgery were observed. Screws had been removed in four patients because of prominence. One patient had fusion in the subtalar joint because of arthritis at 5 years postoperatively. At last follow-up, radiographic signs of developed or progressing arthritis were observed in 9 patients at subtalar joint and in 4 patients at talonavicular joint. At 1-year follow-up, the mean AOFAS ankle/hindfoot score had increased to 84 from a mean preoperative value of 38 (P<0.01).

Conclusions

Arthroscopic arthrodesis provides surgeons with an alternative to traditional open techniques for the management of severe ankle arthritis. Preparation of the joint surface with microfracture has been demonstrated to increase the union rate of arthroscopic ankle arthrodesis, while bone graft and other promoting substance are not necessary to be routinely used.