Ankle Arthrodesis, Approach and Surgical Techniques.pptx

Ankle Fusion Approach Techniques

1. Ankle Arthrodesis Suresh Pandey Professor and Head Orthopedics, COMS NOA Chitwan Ankle foot Symposium 2024

2. Problem statement Disabling end stage arthritis common Options of treatment varies with variable outcome 4 AA /100,000 population NOA Chitwan Ankle foot Symposium 2024

3. Anatomy NOA Chitwan Ankle foot Symposium 2024

4. Stability NOA Chitwan Ankle foot Symposium 2024

5. History: Ankle arhrodesis Fusion of Tibiotalar joint Coined by the Austrian surgeon Eduard Albert in 1878 Common procedure for end stage ankle arthropathy NOA Chitwan Ankle foot Symposium 2024

6. Why Ankle Arthordesis Indications End stage disabling arthritis Post-Traumatic (70%) Infection AVN RA Gout Inflammatory arthropathy NOA Chitwan Ankle foot Symposium 2024

7. Indications of Arthrodesis… Failed arthroplasty AVN Deformity Charcot Joint NOA Chitwan Ankle foot Symposium 2024

8. Relative Contraindications Poor vascularity Marked Peripheral neuropathy Severe deformity NOA Chitwan Ankle foot Symposium 2024

9. Arthordesis vs Arthroplasty Indications and Superiority NOA Chitwan Ankle foot Symposium 2024

10. Fusion has higher rate of Wound dehiscence Nonunion Infection NOA Chitwan Ankle foot Symposium 2024

11. Arthrodesis: Is it gold standard? Higher complications rate (up to 40%) Loss of motion Adjacent joint degeneration Inferior satisfaction rate NOA Chitwan Ankle foot Symposium 2024

12. What has changed? Better results with fewer complications Fusion rate 90-99 percent Better soft tissue care Better implant and fixation NOA Chitwan Ankle foot Symposium 2024

13. Surgical Technique >30 techniques described Open: Moderate to severe deformity Arthroscopic: Mild or no deformity Poor skin condition Higher risk of wound complications NOA Chitwan Ankle foot Symposium 2024

14. Contraindications of Arthroscopic arthrodesis Large bone defect Moderate to severe deformity Active infection Previous failed arthrodesis NOA Chitwan Ankle foot Symposium 2024

15. Goal Plantigrade foot, painless walking with minimal limb length discrepancy NOA Chitwan Ankle foot Symposium 2024

16. Approaches Anterior Lateral Medial Posterior Combined NOA Chitwan Ankle foot Symposium 2024

17. Anterior Most common Good exposure Useful for coronal plane displacement of Talus Plane between TA medially and EHL along with NV bundle laterally Between EHL and EDL alternatively NOA Chitwan Ankle foot Symposium 2024

18. Anterior NOA Chitwan Ankle foot Symposium 2024 Take care of Medial and Intermediate branch of cut n Incise Retinaculum and Capsule

19. Intraop Attention Adequate exposure Respect to soft tissue Adequate debridement Proper bed, contact surface and fixation NOA Chitwan Ankle foot Symposium 2024

20. Techniques of surface preparation Curette Chisel/osteotome Rounger Burr Saw Drill Malleolar osteotomy NOA Chitwan Ankle foot Symposium 2024

21. Techniques of Fixation Internal External: Active Infection or poor skin condition Inferior results NOA Chitwan Ankle foot Symposium 2024

22. Internal Fixation Hardware Screws Plate Retrograde Nail Plate and screws NOA Chitwan Ankle foot Symposium 2024

23. Internal Fixation: Best choice? Plate Screw Nail (subtalar fusion) combination NOA Chitwan Ankle foot Symposium 2024

24. Configuration and number of Screws 2 or more Parallel, cross Antegrade Retrograde Combinations NOA Chitwan Ankle foot Symposium 2024

25. Position of Fusion 0-5 deg valgus Neutral 0-5 deg ER Talus at centre in AP and Lat view Slight posterior position of Talus to use maximum contact surface and reduce anterior lever arm NOA Chitwan Ankle foot Symposium 2024

26. Avoid… Anterior position of Talus Over-resection and shortening Lateral malleolus impingement NOA Chitwan Ankle foot Symposium 2024

27. Role of BG Bone loss Failed arthrodesis Gap Higher fusion rate Avoid valgus/varus NOA Chitwan Ankle foot Symposium 2024

28. PostOp Rehab 6 weeks of non- wt bearing cast Gradual to full wt bearing as per union assessment NOA Chitwan Ankle foot Symposium 2024

29. Fusion rate 89% (64%-100%) A rthroscopic arthrodesis was 94% (range: 70%-100%) NOA Chitwan Ankle foot Symposium 2024

30. What would be life like? Painless stable joint Gait Speed Break reaction time Adjacent joint arthropathy due to excess stress and compensatory mobility NOA Chitwan Ankle foot Symposium 2024

31. Important Take aways Proper selection of patient Respect to soft tissue Proper joint preparation Stable fixation Address bone loss/gap NOA Chitwan Ankle foot Symposium 2024

32. Thank You NOA Chitwan Ankle foot Symposium 2024 Thank you