Medicine:Ankle fusion
Ankle fusion, or ankle arthrodesis, is surgery of the ankle to fuse the bones to treat arthritis and for other purposes.[1] There are different types of ankle fusion surgery. The surgery involves the use of screws, plates, medical nails, and other hardware to achieve bone union.[1] Ankle fusion is considered to be the gold standard for treatment of end-stage ankle arthritis.[1] It trades joint mobility for relief from pain. Complications may include infection, non-union, and, rarely, amputation.[1]
Outcomes
A randomised controlled trial comparing ankle replacement with ankle fusion found that both led to similar improvements in walking, standing and quality of life. Fixed bearing (but not mobile bearing) ankle replacements outperformed ankle fusion in a separate analysis. A cost-effectiveness analysis revealed that ankle replacement may be better value for money over the course of a person’s lifetime.[2][3]
Tibiotalocalcaneal arthrodesis
Tibiotalocalcaneal (TTC) arthrodesis is a special type of ankle fusion.[4][5][6][7] It is used in select situations, for instance as a salvage therapy in severe complicated cases of ankle deformity or in other situations.[4][8] One major approach to TTC arthrodesis uses an intramedullary (IM) medical nail.[4][9][10][5][6] A 2011 systematic review reported the rate of bone union to be 87%, with a range of 74 to 93% in different studies.[9] The average time to union was 4.5 months.[9] Only 26% of cases of non-union required revision fusion, with the remaining cases being asymptomatic or not being severe enough to require revision.[9] It was concluded that the nail can oftentimes provide structural support and relief from pain even without union.[9] The complication rate was 56%, with hardware-related problems comprising a majority of complications.[9] The rate of reoperation was 22%, with screw removal done in 11.4%, nail removal done in 4.2%, revision fusion done in 3.4%, and amputation in 1.5%.[9] The review concluded that there is a good fusion rate with TTC arthrodesis using an IM nail but that the surgery has a high rate of complications.[9] On the other hand, a 2016 review concluded that there was a low rate of complications.[10]
See also
References
- ↑ 1.0 1.1 1.2 1.3 "Ankle Arthrodesis - a Review of Current Techniques and Results". Acta Chir Orthop Traumatol Cech 87 (4): 225–236. 2020. doi:10.55095/achot2020/035. PMID 32940217.
- ↑ Goldberg, Andrew J.; Chowdhury, Kashfia; Bordea, Ekaterina; Blackstone, James; Brooking, Deirdre; Deane, Elizabeth L.; Hauptmannova, Iva; Cooke, Paul et al. (2023-03-30). "Total ankle replacement versus ankle arthrodesis for patients aged 50 85 years with end-stage ankle osteoarthritis: the TARVA RCT" (in EN). Health Technology Assessment 27 (5): 1–80. doi:10.3310/PTYJ1146. ISSN 2046-4924. PMID 37022932. PMC 10150410. https://www.journalslibrary.nihr.ac.uk/hta/ptyj1146/.
- ↑ "Severe ankle osteoarthritis: which surgery should I have?". NIHR Evidence. 9 January 2024. https://evidence.nihr.ac.uk/alert/severe-ankle-osteoarthritis-which-surgery-should-i-have/.
- ↑ 4.0 4.1 4.2 "Primary tibiotalocalcaneal arthrodesis". Foot Ankle Clin 16 (1): 115–36. March 2011. doi:10.1016/j.fcl.2010.12.001. PMID 21338935.
- ↑ 5.0 5.1 "Tibiotalocalcaneal Arthrodesis for Foot and Ankle Deformities". Clin Podiatr Med Surg 34 (3): 357–380. July 2017. doi:10.1016/j.cpm.2017.02.007. PMID 28576195.
- ↑ 6.0 6.1 "Tibiotalocalcaneal Fusion for Severe Deformity and Bone Loss". J Am Acad Orthop Surg 24 (3): 125–34. March 2016. doi:10.5435/JAAOS-D-14-00102. PMID 26829585.
- ↑ "Tibiotalocalcaneal arthrodesis for salvage of severe ankle degeneration". Clin Podiatr Med Surg 26 (2): 283–302. April 2009. doi:10.1016/j.cpm.2008.12.009. PMID 19389600.
- ↑ Yang, Chalen; Spacek, Ashley E.; Abicht, Bradly P. (2023). "Tibiotalocalcaneal arthrodesis using a posteriorly angled nail for definitive fixation augmented with fibular onlay graft and autogenous tibial bone graft within the surgical technique of retrograde-delivered locked compression nail: A case series". Foot & Ankle Surgery: Techniques, Reports & Cases 3 (3): 100307. doi:10.1016/j.fastrc.2023.100307. ISSN 2667-3967. https://doi.org/10.1016/j.fastrc.2023.100307.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 "The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature". Acta Orthop Belg 77 (5): 644–51. October 2011. PMID 22187841.
- ↑ 10.0 10.1 "Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review". Knee Surg Sports Traumatol Arthrosc 24 (4): 1316–25. April 2016. doi:10.1007/s00167-015-3548-1. PMID 25715850.
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