Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2016; 7(11): 700-708
Published online Nov 18, 2016. doi: 10.5312/wjo.v7.i11.700
Ankle arthrodesis: A systematic approach and review of the literature
Youichi Yasui, Charles P Hannon, Dexter Seow, John G Kennedy
Youichi Yasui, Charles P Hannon, Dexter Seow, John G Kennedy, Hospital for Special Surgery, New York, NY 10021, United States
Youichi Yasui, Charles P Hannon, Dexter Seow, Department of Orthopaedic Surgery, 2nd Teikyo University School of Medicine, Tokyo 1738606, Japan
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Kennedy JG is a consultant who has received research support from the Ohnell Family Foundation.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: John G Kennedy, MD, MCh, MMSc, FRCS (Orth), Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY 10021, United States. kennedyj@hss.edu
Telephone: +1-646-7978880 Fax: +1-646-7978966
Received: May 16, 2016
Peer-review started: May 16, 2016
First decision: July 11, 2016
Revised: August 23, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: November 18, 2016
Processing time: 184 Days and 9.3 Hours
Abstract

Ankle arthrodesis is a common treatment used for patients with end-stage ankle arthritis (ESAA). The surgical goal of ankle arthrodesis is to obtain bony union between the tibia and talus with adequate alignment [slight valgus (0°-5°)], neutral dorsiflexion, and slight external rotation positions) in order to provide a pain-free plantigrade foot for weightbearing activities. There are many variations in operative technique including deferring approaches (open or arthroscopic) and differing fixation methods (internal or external fixation). Each technique has its advantage and disadvantages. Success of ankle arthrodesis can be dependent on several factors, including patient selection, surgeons’ skills, patient comorbidities, operative care, etc. However, from our experience, the majority of ESAA patients obtain successful clinical outcomes. This review aims to outline the indications and goals of arthrodesis for treatment of ESAA and discuss both open and arthroscopic ankle arthrodesis. A systematic step by step operative technique guide is presented for both the arthroscopic and open approaches including a postoperative protocol. We review the current evidence supporting each approach. The review finishes with a report of the most recent evidence of outcomes after both approaches and concerns regarding the development of hindfoot arthritis.

Keywords: Ankle; Osteoarthritis; Arthrodesis; Review; Ankle fusion

Core tip: Ankle arthrodesis is an effective treatment option for end stage arthritis. There is no current consensus on the most optimal approach and fixation method. It is thus important for the surgeon to understand both the open and arthroscopic approach and when each approach is indicated. Joint alignment must be slightly valgus (0°-5°), neutrally dorsiflexed and slightly in an externally rotated position. Limb length discrepancies should also be minimal (less than 2.5 cm or 1.0 inch). Failure to address these biomechanical aspects may result in pain and an altered gait pattern. The importance of adequate preoperative forefoot balance cannot be understated to allow for successful postoperative mobility. When performed according to these principles ankle arthrodesis leads to functional improvement and adequate joint fusion in patients with end stage arthritis.