ANKLE FUSION: A DURABLE RESULT THAT CAN HOLD UP TO STRESS James - - PowerPoint PPT Presentation
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
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
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
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 PATIENTS FUSION RATE AVG TIME TO FUSION (wks) Myerson & Quill 1991 17 100% 8.7 DeVriese et al. 1994 10 70% 16 Dent et al. 1993 8 100% NA Corso & Zimmer 1995 16 100% 9.5 Glick et al. 1996 34 97% 9
LITERATURE
AUTHOR YEAR NUMBER OF PATIENTS FUSION RATE AVG TIME TO FUSION (WKS) Cameron & Ullrich 2000 15 100% 11.5 Ferkel & Hewitt 2005 35 97% 11.8 Gougoulias et al. 2007 78 97% 12.4 Townshend et al. 2013 30 97% NA 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
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
ARTHROSCOPIC ANKLE ARTHRODESIS O’BRIEN, STONE, SHEREFF, JOHNSON
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”
ATHLETIC
POPULATION
ADVOCATES FOR
ANKLE REPLACEMENT
THIS IS MY LIFE GO FOR AN ANKLE
FUSION
GOOD LONG TERM
RESULTS
RETURN TO HIGH
DEMAND ACTIVITIES
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