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Open arthrodesis effective in arthritic ankles with severe coronal deformities
All patients reported reduced pain and better walking ability compared to presurgical status.
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Open arthrodesis can be an effective treatment option for patients with ankle osteoarthritis and severe varus or valgus coronal plane deformity, according to an investigation by British surgeons.
Robert Smith, MBChB, FRCS(Tr&Orth), and Peter L.R. Wood, MBBS, FRCS, of the Wrightington Hospital in Wigan, England, reviewed outcomes for 25 consecutive open ankle arthrodeses performed in 23 patients and a mean age of 62 years. Six patients had post-traumatic arthritis and 17 had generalized primary osteoarthritis.
All cases had a severe deformity of at least 20° in the coronal plane, according to the study, published in the British edition of the Journal of Bone and Joint Surgery.
The operating surgeon performed the arthrodesis using an anterior approach. In 19 cases, fixation was achieved using two parallel 6.5-mm cannulated screws with washers [ACE; DePuy], which were placed under radiographic control using an image intensifier. One additional screw was used in six cases, and a guide block was used in all ankles to ensure the screws were parallel, according to the study.
If necessary, the operating surgeon also performed a fibular osteotomy in ankles with a varus deformity, "in order to achieve a full correction and to place the foot in a neutral plantigrade position," the authors reported.
Patients were placed in a weight-bearing cast between 1 and 3 days postop and mobilized. After 6 weeks, the sutures were removed and patients were placed in a another cast that allowed free weight-bearing for another 6 weeks.
Nonunion occurred in one ankle, which eventually required revision with bone grafting. A solid fusion was achieved at 24 months after the primary surgery and the patient returned to full activity with little pain, the authors reported.
For the 24 ankles that achieved primary union, the mean American Orthopaedic Foot and Ankle Society (AOFAS) pain score improved from a preoperative 10.5 points to 35.2 points postoperatively.
The mean AOFAS function score also improved, from 25.5 points preoperatively to 43.7 points after surgery, according to the study.
All patients reported reduced pain and could walk greater distances compared to before surgery, the authors noted. "All the patients were pleased with the outcome of surgery as regards to reduction in pain, walking distance and the overall result," they wrote.
A mean correction of 25° was achieved in 18 ankles, and these ankles had a residual deformity within 5° of neutral.
Surgery achieved a mean correction of 21° in the remaining seven ankles, and these ankles had a mean residual deformity of 9°, according to the study.
For more information:
- Smith R, Woor PLR. Arthrodesis of the ankle in the presence of a large deformity in the coronal plane. J Bone Joint Surg Br. 2007;89-B:615-619.