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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


  1. 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

  2. DISCLOSURE  NO INDUSTRY CONFLICTS  BOARD OF DIRECTORS ARTHROSCOPY ASSOCIATION OF NORTH AMERICA

  3. ANKLE ARTHRODESIS: INDICATIONS  PAIN  DEFORMITY  INSTABILITY

  4. TRADITIONAL APPROACH: OPEN SURGERY

  5. ARTHROSCOPIC ANKLE ARTHRODESIS: HISTORY HIGH COMPLICATION RATE OF OPEN PROCEDURE 60% OVERALL COMPLICATIONS 20% PSEUDARTHROSIS 5-25% INFECTION

  6. 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

  7. SURGICAL PROCEDURE

  8. ANKLE ARTHROSCOPY ANTERIOR PORTAL POSITIONS

  9. ANKLE ARTHROSCOPY POSTEROLATERAL PORTAL

  10. ANKLE ARTHROSCOPY SETUP

  11. STEP 3: SECONDARY DEBRIDEMENT

  12. STEP 4: ABRASION OF SURFACES

  13. STEP 5: ASSESS SURFACES FOR BLEEDING

  14. STEP 7:  REMOVE LEG FROM HOLDER AND EXTEND  HOLD ANKLE IN REDUCED POSITION  DRIVE PINS  PLACE SCREWS  CONFIRM ADEQUATE REDUCTION AND SCREW PLACEMENT

  15. ARTHROSCOPIC ANKLE FUSION ANKLE POSITION  SLIGHT VALGUS  NEUTRAL DORSIFLEXION/PLANTARFLEXION  AVOID HINDFOOT VARUS

  16. FIXATION: TWO MEDIAL PINS

  17. FIXATION: CROSSED TRANSMALLEOLAR PINS

  18. 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

  19. 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

  20. 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

  21. 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

  22. ARTHROSCOPIC ANKLE ARTHRODESIS O ’ BRIEN, STONE, SHEREFF, JOHNSON  FUSION RATE  3/17 NONUNIONS IN OPEN GROUP  1/19 NONUNIONS IN ARTHROSCOPIC GROUP

  23. 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

  24. 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

  25. SPORTS PARTICIPATION, FUNCTIONAL OUTCOME, AND COMPLICATIONS AFTER ANKLE ARTHRODESIS: MIDTERM FOLLOWUP KERKHOFF ET AL. FOOT ANKLE INT 2017

  26. 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%

  27. 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

  28. Maffulli et al. 2017  OUTCOME OF ANKLE ARTHRODESIS AND ANKLE PROSTHESIS: A REVIEW OF THE CURRENT STATUS  LEVEL III: SYSTEMATIC REVIEW

  29. 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”

  30. DR. BERLET  ATHLETIC POPULATION  ADVOCATES FOR ANKLE REPLACEMENT

  31. DR. STONE  THIS IS MY LIFE  GO FOR AN ANKLE FUSION  GOOD LONG TERM RESULTS  RETURN TO HIGH DEMAND ACTIVITIES

  32. 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

  33. THANK YOU

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