Open Ankle Arthrodesis
Arthritis of the ankle can be disabling, often causing substantial impairment and disability. Prior trauma is the most common cause of ankle arthritis. Ankle arthritis may entail early degenerative changes or more involved and extensive “end-stage” diseas
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Open Ankle Arthrodesis Jeremy T. Smith and Christopher P. Chiodo
Background Ankle arthrodesis, also referred to as ankle fusion, is a commonly performed surgical procedure used most often for the treatment of end-stage ankle arthritis. Ankle arthrodesis was first described by Albert is 1879, involving attempted fusion without fixation [1]. In 1951, Charnley described his experiences with both ankle and shoulder arthrodesis, introducing the concept of compression for ankle joint fusion [2]. For the ankle, this was accomplished through an anterior transverse incision, flat cuts made for the tibial and talus, followed by application of a spanning external fixator. Charnley reported the outcomes of 19 patients, gaining a bony union in fifteen of them and painless fibrous union in the remaining four patients. In his paper, he describes the challenge of obtaining a successful fusion, writing that “with compression arthrodesis in the ankle it would appear that this joint does not possess the same natural potential for bony union as exists in the soft cancellous bone of the knee.” He also cautioned that “the writer does not wish to minimise the fact that the methods [of ankle fusion] perhaps demand a little more mechanical aptitude than is necessary in most orthopedic procedures.” Charnley’s emphasis on compression as a method to achieve bony union is a principle that has endured. Modern techniques of ankle fusion rely upon compression, more commonly now with internal fixation devices that external fixation. In the 1980s, Mann popularized a utilitarian approach to ankle fusion [3]. This technique is a lateral trans-fibular approach that resects the distal fibula and enables bony apposition through flat cuts of the distal tibial and talus. Numerous additional approaches and techniques for ankle arthrodesis have since been described. These
J.T. Smith (*) • C.P. Chiodo Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA e-mail: [email protected] © Springer International Publishing AG 2018 C.P. Chiodo, J.T. Smith (eds.), Foot and Ankle Fusions, https://doi.org/10.1007/978-3-319-43017-1_1
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J.T. Smith and C.P. Chiodo
all rely upon four core principles, which in our opinion remain requirements for a successful outcome: apposition of viable bone surfaces, optimal ankle alignment, stable fixation, and compression. More recently, less invasive “mini-open” and arthroscopic techniques have been described. These approaches are attractive because they minimize wound complications and preserve vascularity to the articular surfaces undergoing fusion. Smaller incision approaches, however, can be technically challenging and are not appropriate for all patients, including patients with severe deformity. Open ankle arthrodesis therefore remains an essential tool for the treatment for end-stage ankle arthritis.
Indications Ankle arthrodesis is most commonly performed as a treatment for end-stage ankle arthritis. Although substantially less common that arthritis of the hip and knee, ankle arthritis frequently
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