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Updated: Jun 8 2021

Ankle Arthrodesis

Images fusion.jpg nail_moved.jpg
  • summary
    • Ankle arthrodesis is the fusion of the tibiotalar joint most commonly performed for end-stage arthritis of the joint.
    • The procedure may be performed with an open approach or arthroscopically. 
    • The most common complications are development of subtalar arthritis and nonunion. 
  • Indications
    • Indications
      • painful arthritis following
        • infection
        • trauma (most common cause)
        • chronic instability
        • AVN of the talus
        • inflammatory arthropathy
        • primary OA
      • neuropathic arthropathy
      • tumor resection
      • salvage for failed ORIF
      • salvage for failed TAA
  • Technique
    • Optimal Position
      • neutral dorsiflexion
      • 5-10° of external rotation
      • 5° of hindfoot valgus
      • 5 mm of posterior talar translation
    • Arthroscopic arthrodesis
      • only indicated if minimal deformity present
    • Open arthrodesis
      • transfibular approach often used when deformity present
        • screw fixation
        • plate and screw construct
        • external fixation
      • fusion of the talonavicular joint decreases hindfoot ROM >90% 
      • staged approach
        • infection should be cleared prior to placement of definitive internal hardware for arthrodesis
    • Tibiotalocalcaneal (TTC) fusion with retrograde intramedullary nail
      • Load-sharing device with improved bending stiffness and rotational stability compared to plate-and-screw constructs
      • Indications:
        • End-stage ankle and subtalar arthritis
        • Charcot neuroarthropathy
        • Significant hindfoot bone loss (failed total ankle arthroplasty, failed arthrodesis)
        • Osteonecrosis of the talus
          • lateral transfibular approach allows for dual joint preparation as well as local autograft
        • Severe acute trauma
      • Contraindications:
        • Active infection
        • Profound vascular disease
        • Severe tibia malalignment
  • Complications
    • Nonunion
      • incidence
        • 10% non union rate
        • tobacco users have 2.7x risk
        • neuropathy is greatest risk factor for persistent nonunion with revision of nonunion
    • Lateral plantar nerve injury
    • Superficial peroneal nerve
      • injury to superficial peroneal nerve during transfibular approach
    • Hindfoot arthritis
      • adjacent hindfoot arthritis commonly occurs following fusion
      • isolated hindfoot arthritis due to chronic pes planus is treated with subtalar joint arthrodesis
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