ANKLE FUSION: A DURABLE RESULT THAT CAN HOLD UP TO STRESS James W. Stone, M.D. Assistant Clinical Professor Orthopedic Surgery Medical College of Wisconsin Milwaukee, Wisconsin DISCLOSURE NO INDUSTRY CONFLICTS BOARD OF DIRECTORS ARTHROSCOPY ASSOCIATION OF NORTH AMERICA ANKLE ARTHRODESIS: INDICATIONS PAIN DEFORMITY INSTABILITY TRADITIONAL APPROACH: OPEN SURGERY ARTHROSCOPIC ANKLE ARTHRODESIS: HISTORY HIGH COMPLICATION RATE OF OPEN PROCEDURE 60% OVERALL COMPLICATIONS 20% PSEUDARTHROSIS 5-25% INFECTION ARTHROSCOPIC ANKLE ARTHRODESIS SCHNEIDER 1983: CASE REPORT AT AANA MEETING 1996: GLICK, MYERSON, MORGAN, SAMPSON: 34 FUSIONS 33/34 SUCCESSFUL FUSIONS AVG. FUSION TIME 9 WEEKS SURGICAL PROCEDURE ANKLE ARTHROSCOPY ANTERIOR PORTAL POSITIONS ANKLE ARTHROSCOPY POSTEROLATERAL PORTAL ANKLE ARTHROSCOPY SETUP STEP 3: SECONDARY DEBRIDEMENT STEP 4: ABRASION OF SURFACES STEP 5: ASSESS SURFACES FOR BLEEDING STEP 7: REMOVE LEG FROM HOLDER AND EXTEND HOLD ANKLE IN REDUCED POSITION DRIVE PINS PLACE SCREWS CONFIRM ADEQUATE REDUCTION AND SCREW PLACEMENT ARTHROSCOPIC ANKLE FUSION ANKLE POSITION SLIGHT VALGUS NEUTRAL DORSIFLEXION/PLANTARFLEXION AVOID HINDFOOT VARUS FIXATION: TWO MEDIAL PINS FIXATION: CROSSED TRANSMALLEOLAR PINS ARTHROSCOPIC ANKLE ARTHRODESIS POSTOPERATIVE CARE POSTERIOR SPLINT OR 3-D WALKER NWB 1 WEEK THEN WBAT IN WALKER MAINTAIN WALKER UNTIL RADIOGRAPHIC FUSION 8-12 WEEKS ROCKER BOTTOM SHOE LITERATURE AUTHOR YEAR NUMBER FUSION RATE AVG TIME TO PATIENTS FUSION (wks) Myerson & 1991 17 100% 8.7 Quill DeVriese et al. 1994 10 70% 16 Dent et al. 1993 8 100% NA Corso & 1995 16 100% 9.5 Zimmer Glick et al. 1996 34 97% 9 LITERATURE AUTHOR YEAR NUMBER OF FUSION AVG TIME TO PATIENTS RATE FUSION (WKS) Cameron & 2000 15 100% 11.5 Ullrich Ferkel & 2005 35 97% 11.8 Hewitt Gougoulias et 2007 78 97% 12.4 al. Townshend et 2013 30 97% NA al. Meng et al. 2013 14 100% NA ARTHROSCOPIC ANKLE ARTHRODESIS O’BRIEN, STONE, SHEREFF, JOHNSON COMPARE 17 OPEN TO 19 ARTHROSCOPIC FUSIONS CONTROLLED FOR PREOPERATIVE PARAMETERS ANKLES UNDERGOING OPEN ARTHRODESIS WOULD HAVE BEEN ACCEPTABLE FOR ARTHROSCOPIC PROCEDURE BY PREOPERATIVE CRITERIA: NO VALGUS/VARUS MALALIGNMENT AND PASSIVELY CORRECTABLE TO NEUTRAL ARTHROSCOPIC ANKLE ARTHRODESIS O’BRIEN, STONE, SHEREFF, JOHNSON FUSION RATE 3/17 NONUNIONS IN OPEN GROUP 1/19 NONUNIONS IN ARTHROSCOPIC GROUP ARTHROSCOPIC ANKLE ARTHRODESIS O’BRIEN, STONE, SHEREFF, JOHNSON POSTOPERATIVE POSITION 35% IN RECOMMENDED POSITION OF DORSI/PLANTAR FLEXION POSTOP IN OPEN GROUP 79% IN RECOMMENDED POSITION OF DORSI/PLANTAR FLEXION IN ARTHROSCOPIC GROUP ARTHROSCOPIC ANKLE ARTHRODESIS O’BRIEN, STONE, SHEREFF, JOHNSON COMPLICATIONS 1 DEEP INFECTION (OPEN GROUP) 1 TIBIAL NERVE ENTRAPMENT (OPEN GROUP) 3 POSTERIOR SUBTALAR DJD (OPEN GROUP) NO POSTOPERATIVE COMPLICATIONS IN ARTHROSCOPIC GROUP SPORTS PARTICIPATION, FUNCTIONAL OUTCOME, AND COMPLICATIONS AFTER ANKLE ARTHRODESIS: MIDTERM FOLLOWUP KERKHOFF ET AL. FOOT ANKLE INT 2017 KERKHOFF ET AL. LEVEL III RETROSPECTIVE COMPARATIVE 185 ANKLES MEAN FU 8 YRS FFI, VAS, FAAM SPORT PARTIC 79.5% 68.9% 73.1% ABLE TO HIKE, MEDIAN 40 MIN FAILURE 9.2%, REOPERATION 8.6% KERKHOFF ET AL SATISFACTORY FUNCTIONAL OUTCOME AND PAIN REDUCTION MOST REMAINED ACTIVE SPORTS BUT TREND TO LESS DEMANDING ACTIVITIES COMPLIC AND FAILURE RATES CONSISTENT W PREVIOUS LITERATURE Maffulli et al. 2017 OUTCOME OF ANKLE ARTHRODESIS AND ANKLE PROSTHESIS: A REVIEW OF THE CURRENT STATUS LEVEL III: SYSTEMATIC REVIEW Maffulli et al. 2017 “ALTHOUGH THERE IS SOME EVIDENCE TO SUPPORT TAR TO CONSERVE ANKLE MOTION AND OFFER IMPROVED FUNCTION AND DECREASED PAIN WITH HIGH SATISFACTION RATES, REVISION RATES FOR TAR ARE SIGNIFICANTLY HIGHER THAN REVISION RATES FOR AA” DR. BERLET ATHLETIC POPULATION ADVOCATES FOR ANKLE REPLACEMENT DR. STONE THIS IS MY LIFE GO FOR AN ANKLE FUSION GOOD LONG TERM RESULTS RETURN TO HIGH DEMAND ACTIVITIES CONCLUSIONS ANKLE FUSION IS AN APPROPRIATE PROCEDURE TO CONSIDER ESPECIALLY IN YOUNG ACTIVE PATIENTS ANKLE FUSION CAN BE PERFORMED ARTHROSCOPICALLY IN PATIENTS WITH MINIMAL DEFORMITY WITH HIGH FUSION RATE AND LOW COMPLICATION RATE THANK YOU.