Clin Orthop Surg.  2018 Sep;10(3):368-373. 10.4055/cios.2018.10.3.368.

Ankle Arthrodesis: A Comparison of Anterior Approach and Transfibular Approach

Affiliations
  • 1Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. bluewhisle@gmail.com
  • 2Department of Orthopaedic Surgery, Busan City Medical Center, Busan, Korea.
  • 3Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea.

Abstract

BACKGROUND
The purpose of this study was to compare clinical and radiological results of arthrodesis performed by the anterior approach and by the transfibular approach in ankle osteoarthritis.
METHODS
Sixty patients underwent open arthrodesis (38 by the anterior approach and 22 by the transfibular approach). The visual analogue scale score and the American Orthopedic Foot and Ankle Society (AOFAS) score were examined clinically, and radiological examination was performed on the alignment of the lower extremity and bone union.
RESULTS
Both groups showed significant improvement in AOFAS score (from 39.8 to 58.3 in the anterior approach group and from 44.5 to 60.7 in the transfibular approach group). There was no significant difference in AOFAS score at the last follow-up in both groups. The time to fusion was 13.5 weeks in the anterior approach group and 11.8 weeks in the transfibular approach group. Nonunion occurred in four cases in the anterior approach group and in one case in the transfibular approach group.
CONCLUSIONS
Ankle arthrodesis by the anterior approach and the transfibular approach showed comparably good clinical results.

Keyword

Ankle; Osteoarthritis; Arthrodesis

MeSH Terms

Ankle*
Arthrodesis*
Follow-Up Studies
Foot
Humans
Lower Extremity
Orthopedics
Osteoarthritis

Figure

  • Fig. 1 Measurement of the hindfoot alignment. The angle between the mid-diaphyseal axis of the tibia and the mid-diaphyseal line of the calcaneus was measured.

  • Fig. 2 Preoperative standing anteroposterior (A) and lateral (B) radiographs of the ankle showing Takakura stage 4 arthritic change in the right ankle joint. (C, D) Ankle arthrodesis was performed with the anterior approach using two 7.0-mm cannulated screws (C: anteroposterior view, D: lateral view). (E) Follow-up anteroposterior view showing fusion of the ankle joint.

  • Fig. 3 Preoperative standing anteroposterior (A) and lateral (B) radiographs of the ankle showing Takakura stage 3 arthritic change in the left ankle joint. (C, D) Ankle arthrodesis was performed with the transfibular approach with two 7.0-mm cannulated screws and fibular onlay bone graft (C: anteroposterior view, D: lateral view). (E) Follow-up anteroposterior view showing fusion of the ankle joint.

  • Fig. 4 (A) Anteroposterior view showing nonunion after ankle arthrodesis with the anterior approach. (B, C) Revision ankle arthrodesis was performed (B: anteroposterior view, C: lateral view).

  • Fig. 5 (A) Anteroposterior view showing nonunion after ankle arthrodesis with the transfibular approach. (B, C) Revision ankle arthrodesis with a fusion plate was performed (B: anteroposterior view, C: lateral view).


Cited by  2 articles

The Epidemiology and Trends of Primary Total Ankle Arthroplasty and Revision Procedure in Korea between 2007 and 2017
Sung Jae Kim, Il-Hoon Sung, Si Young Song, Young-Hoon Jo
J Korean Med Sci. 2020;35(22):e169.    doi: 10.3346/jkms.2020.35.e169.

Comparison of the Outcomes between the Anterior and Transfibular Approaches in Ankle Arthrodesis
Jaeyoung Lee, Min-Jun Kim, Jin-Wha Chung
J Korean Foot Ankle Soc. 2023;27(4):131-136.    doi: 10.14193/jkfas.2023.27.4.131.


Reference

1. Chalayon O, Wang B, Blankenhorn B, et al. Factors affecting the outcomes of uncomplicated primary open ankle arthrodesis. Foot Ankle Int. 2015; 36(10):1170–1179.
Article
2. Akra GA, Middleton A, Adedapo AO, Port A, Finn P. Outcome of ankle arthrodesis using a transfibular approach. J Foot Ankle Surg. 2010; 49(6):508–512.
Article
3. Morgan CD, Henke JA, Bailey RW, Kaufer H. Long-term results of tibiotalar arthrodesis. J Bone Joint Surg Am. 1985; 67(4):546–550.
Article
4. Reilingh ML, Beimers L, Tuijthof GJ, Stufkens SA, Maas M, van Dijk CN. Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skeletal Radiol. 2010; 39(11):1103–1108.
Article
5. Robinson I, Dyson R, Halson-Brown S. Reliability of clinical and radiographic measurement of rearfoot alignment in a patient population. The Foot. 2001; 11(1):2–9.
Article
6. Pak CH, Lee JY, Jeong YJ. Ankle arthrodesis outcomes in ankle osteoarthritis: comparison between anterior approach and transfibular approach. J Korean Foot Ankle Soc. 2014; 18(4):189–194.
Article
7. Sung W, Greenhagen RM, Hobizal KB, Burns PR, Wukich DK. Technical guide: transfibular ankle arthrodesis with fibular-onlay strut graft. J Foot Ankle Surg. 2010; 49(6):566–570.
Article
8. Mann RA, Rongstad KM. Arthrodesis of the ankle: a critical analysis. Foot Ankle Int. 1998; 19(1):3–9.
Article
9. Mann RA, Van Manen JW, Wapner K, Martin J. Ankle fusion. Clin Orthop Relat Res. 1991; (268):49–55.
10. Wang GJ, Shen WJ, McLaughlin RE, Stamp WG. Transfibular compression arthrodesis of the ankle joint. Clin Orthop Relat Res. 1993; (289):223–227.
Article
11. Thordarson DB, Markolf KL, Cracchiolo A 3rd. Arthrodesis of the ankle with cancellous-bone screws and fibular strut graft: biomechanical analysis. J Bone Joint Surg Am. 1990; 72(9):1359–1363.
Article
12. Stranks GJ, Cecil T, Jeffery IT. Anterior ankle arthrodesis with cross-screw fixation: a dowel graft method used in 20 cases. J Bone Joint Surg Br. 1994; 76(6):943–946.
Article
13. Moeckel BH, Patterson BM, Inglis AE, Sculco TP. Ankle arthrodesis: a comparison of internal and external fixation. Clin Orthop Relat Res. 1991; (268):78–83.
14. Johnson JE, Lamdan R, Granberry WF, Harris GF, Carrera GF. Hindfoot coronal alignment: a modified radiographic method. Foot Ankle Int. 1999; 20(12):818–825.
Article
15. O'Brien TS, Hart TS, Shereff MJ, Stone J, Johnson J. Open versus arthroscopic ankle arthrodesis: a comparative study. Foot Ankle Int. 1999; 20(6):368–374.
16. Kish G, Eberhart R, King T, Holzaepfel JL, Pollock T. Ankle arthrodesis placement of cannulated screws. Foot Ankle. 1993; 14(4):223–224.
Article
17. Nielsen KK, Linde F, Jensen NC. The outcome of arthroscopic and open surgery ankle arthrodesis: a comparative retrospective study on 107 patients. Foot Ankle Surg. 2008; 14(3):153–157.
18. Holt ES, Hansen ST, Mayo KA, Sangeorzan BJ. Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res. 1991; (268):21–28.
19. Monroe MT, Beals TC, Manoli A 2nd. Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws. Foot Ankle Int. 1999; 20(4):227–231.
Article
20. Gordon D, Zicker R, Cullen N, Singh D. Open ankle arthrodeses via an anterior approach. Foot Ankle Int. 2013; 34(3):386–391.
Article
21. Nihal A, Gellman RE, Embil JM, Trepman E. Ankle arthrodesis. Foot Ankle Surg. 2008; 14(1):1–10.
Article
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