2017 ISAKOS Biennial Congress ePoster #105

 

To Fuse or Not to Fuse: That is the Question

Naren G. Gurbani, MD; FACS; FAAOS, Capistrano Beach, CA UNITED STATES
Kaiser Permanante and Harbor-UCLA Medical Centers, Downey and Torrance, California, UNITED STATES

FDA Status Cleared

Summary

A comparative analysis and review of literature regarding benefits versus risks and outcome results of Arthroscopic Ankle Arthrodesis and Ankle replacement procedures

Abstract

Hypotheses/Purpose: For the management of debilitating end stage arthritis of ankle joint after exhausting all non-surgical modalities, there are logically only two surgical treatment options remaining, to fuse or to replace. Traditionally, open arthrodesis of ankle joint has been considered to be the gold standard with a variety of different procedures available to eliminate the painful remaining range of motion. Due to technological advances in arthroscopy equipment and implant designs, arthroscopic ankle arthrodesis has evolved as a safe and effective alternative to open arthrodesis. However, there is a desire amongst patients and Orthopedic surgeons alike, to preserve the motion of ankle and achieve good long term results with ankle replacement. The purpose of this presentation is to review current literature and to resolve the dilemma as to which should be the gold standard, arthroscopic ankle arthrodesis or total ankle replacement.

Conclusions/Significance: Arthroscopic Ankle Arthrodesis procedure results in higher arthrodesis rate, has shorter fusion time, and is more cost effective due to minimal implant costs. Therefore, it should be considered as a new gold standard versus open ankle arthrodesis. Author proposes that total ankle replacement arthroplasty results should be compared to arthroscopic ankle arthrodesis.

Summary of Methods/Results: Although many gait analyses studies have proven that after total ankle replacement, gait pattern is better, however, the preservation and/or improvement of range of motion is only 0 to 14 degrees. Therefore, incidence of adjascent joint arthritis is less but not eliminated. However, the need for additional procedures for bony or ligamentous deformity correction, hospital stay, rehabilitation time and implant coasts are higher after total ankle replacement. Revision surgery due to loosening and breakage of implants and subsequent surgery for secondary fusion are unique issues to replacement failures. In one study, major revision surgery rate at 5 yrs was 23% in ankle replacement and 11% in ankle arthrodesis cases. A our series of 171 patients, arthroscopic arthrodesis was performed to treat a variety of end stage ankle arthritis even with severe deformities. All surgeries were performed on outpatient basis. Only implants required were two cannulated screws which are inserted from medial and lateral tibial surfaces with ankle under compression. Postoperative care included non-weight bearing for two weeks followed by incremental weight bearing as tolerated in cam-walker. In 163 patients, union was achieved in average time of eight weeks as determined by serial X-rays. The arthrodesis rate was 95%.