Top

European Journal of Orthopaedic Surgery & Traumatology

21-04-2024 | Osteoarthrosis | Original Article

Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique

Authors: Anton A. Semenistyy, Raytcho I. Kehayov

Published in: European Journal of Orthopaedic Surgery & Traumatology

Abstract

Purpose

The purpose of our work was to demonstrate the surgical technique of ankle arthrodesis using the minimally-invasive transfibular (MITF) approach, which minimizes soft tissue damage and is advantageous for high-risk patients.

Methods

In this prospective study, a total of 12 patients with end-stage varus ankle osteoarthritis, including high-risk individuals, underwent ankle arthrodesis using the MITF approach. The technique involves a unique osteotomy at the joint space level, minimizing soft tissue detachment from the fibula. The primary outcomes assessed included bony union, time to weight-bearing, correction of varus deformity, and functional outcomes measured by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. However, the study’s limitations encompass a small sample size and the absence of a control group.

Results

At 6 months post-operation, all patients achieved bony union, with a mean time to union of 13.7 ± 5.2 weeks. The average time to initiate weight-bearing without additional support was 11.2 ± 3.8 weeks. Preoperative varus deformity (17.08 ± 8.36 degrees) and talar tilt (8.75 ± 4.33 degrees) were successfully corrected, with postoperative alignment within 0–5 degrees of valgus. Functional outcomes showed a significant improvement in AOFAS scores from 37.83 ± 7.79 points preoperatively to 77.42 ± 5.63 points one year after surgery (p = 0.002). Minor complications occurred in two patients, both effectively treated with local therapy and antibiotics.

Conclusions

The MITF approach for ankle arthrodesis demonstrates promising results in addressing end-stage varus ankle osteoarthritis, even in high-risk patients. However, the study’s limitations highlight the need for a prospective comparative clinical trial with a larger sample size to ascertain the technique’s effectiveness and safety definitively.

Li Y, Zhang H (2023) Ankle arthritis: joint-preserving surgery and total ankle arthroplasty. Chin j reparative reconst surg 37(7):769–775. https://doi.org/10.7507/1002-1892.202306039CrossRef

Li X, Xu X (2022) Joint preservation for posttraumatic ankle arthritis after tibial plafond fracture. Foot Ankle Clin 27(1):73–90. https://doi.org/10.1016/j.fcl.2021.11.005CrossRefPubMed

Yasui Y, Hannon CP, Seow D, Kennedy JG (2016) Ankle arthrodesis: a systematic approach and review of the literature. World J Orthop 7(11):700–708. https://doi.org/10.5312/wjo.v7.i11.700CrossRefPubMedPubMedCentral

Syed F, Ugwuoke A (2018) Ankle arthroplasty: a review and summary of results from joint registries and recent studies. EFORT Open Rev 3(6):391–397. https://doi.org/10.1302/2058-5241.3.170029CrossRefPubMedPubMedCentral

Adukia V, Mangwani J, Issac R, Hussain S, Parker L (2020) Current concepts in the management of ankle arthritis. J Clin Orthop Trauma 11(3):388–398. https://doi.org/10.1016/j.jcot.2020.03.020CrossRefPubMedPubMedCentral

Nogod S, Khairy AMM Jr, Nubi OG, Fatooh MS, Abd-Elmaged MA, H. (2023) Ankle arthrodesis: indications, outcomes, and patient satisfaction. Cureus 15(4):e37177. https://doi.org/10.7759/cureus.37177CrossRefPubMedPubMedCentral

Hendrickx RP, Stufkens SA, de Bruijn EE, Sierevelt IN, van Dijk CN, Kerkhoffs GM (2011) Medium- to long-term outcome of ankle arthrodesis. Foot Ankle Int 32(10):940–947. https://doi.org/10.3113/FAI.2011.0940CrossRefPubMed

Ebalard M, Le Henaff G, Sigonney G, Lopes R, Kerhousse G, Brilhault J, Huten D (2014) Risk of osteoarthritis secondary to partial or total arthrodesis of the subtalar and midtarsal joints after a minimum follow-up of 10 years. Orthop Traumatol Surg Res 100:7. https://doi.org/10.1016/j.otsr.2014.03.003CrossRef

Wong LH, Chrea B, Meeker JE, Yoo JU, Atwater LC (2022) Factors associated with nonunion and infection following ankle arthrodesis using a large claims database: who has elevated risk? Foot & Ankle Orthopaedics 7(2):24730114221101616. https://doi.org/10.1177/24730114221101617CrossRef

10.

Collman DR, Kaas MH, Schuberth JM (2006) Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients. Foot Ankle Int 27(12):1079–1085. https://doi.org/10.1177/107110070602701214CrossRefPubMed

11.

Cameron SE, Ullrich P (2000) Arthroscopic arthrodesis of the ankle joint. Arthroscopy 16(1):21–26. https://doi.org/10.1016/s0749-8063(00)90123-3CrossRefPubMed

12.

Nickisch F, Avilucea FR, Beals T, Saltzman C (2011) Open posterior approach for tibiotalar arthrodesis. Foot Ankle Clin 16(1):103–114. https://doi.org/10.1016/j.fcl.2010.11.001CrossRefPubMed

13.

Dekker RG 2nd, Kadakia AR (2017) Anterior approach for ankle arthrodesis. JBJS Essent Surg Tech 7(2):e10. https://doi.org/10.2106/JBJS.ST.15.00066CrossRefPubMedPubMedCentral

14.

Balaji SM, Selvaraj V, Devadoss S, Devadoss A (2017) Transfibular ankle arthrodesis: a novel method for ankle fusion - A short term retrospective study. Indian J Orthop 51(1):75–80. https://doi.org/10.4103/0019-5413.197549CrossRefPubMedPubMedCentral

15.

Schuberth JM, Cheung C, Rush SM, Blitz N, Roling B (2005) The medial malleolar approach for arthrodesis of the ankle: a report of 13 cases. J Foot Ankle Surg 44(2):125–132. https://doi.org/10.1053/j.jfas.2005.01.012CrossRefPubMed

16.

Holt ES, Hansen ST, Mayo KA, Sangeorzan BJ (1991) Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res 268:21–28

17.

Moore TJ, Prince R, Pochatko D, Smith JW, Fleming S (1995) Retrograde intramedullary nailing for ankle arthrodesis. Foot Ankle Int 16(7):433–436. https://doi.org/10.1177/107110079501600710CrossRefPubMed

18.

Gharehdaghi M, Rahimi H, Mousavian A (2014) Anterior ankle arthrodesis with molded plate: technique and outcomes. Arch Bone Jt Surg 2(3):203–209PubMedPubMedCentral

19.

Hawkins, B. J., Langerman, R. J., Anger, D. M., Calhoun, J. H., (1993) The Ilizarov technique in ankle fusion a preliminary report. vol 53, pp. 17–21, New York; Bulletin Hospital for Joint Diseases

20.

Colman AB, Pomeroy GC (2007) Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome. Foot Ankle Int 28(3):303–307. https://doi.org/10.3113/FAI.2007.0303CrossRefPubMed

21.

Horwitz T (1942) The use of the transfibular approach in arthrodesis of the ankle joint. Am J Surg 55:550–552CrossRef

22.

Braly WG, Baker JK, Tullos HS (1994) Arthrodesis of the ankle with lateral plating. Foot Ankle Int 15(12):649–653. https://doi.org/10.1177/107110079401501204CrossRefPubMed

23.

AlSayel F, Valderrabano V (2019) Arthrodesis of a varus ankle. Foot Ankle Clin 24(2):265–280. https://doi.org/10.1016/j.fcl.2019.02.009CrossRefPubMed

24.

Kim JG, Ha DJ, Gwak HC, Kim CW, Kim JH, Lee SJ, Kim YJ, Lee CR, Park JH (2018) Ankle arthrodesis: a comparison of anterior approach and transfibular approach. Clin Orthop Surg 10(3):368–373. https://doi.org/10.4055/cios.2018.10.3.368CrossRefPubMedPubMedCentral

25.

Chinnakkannu K, McKissack HM, He JK, Alexander B, Wilson J, Viner GC, Shah A (2020) Mini-open versus transfibular approach for ankle arthrodesis, which approach is superior in joint preparation a cadaver study. Indian J Orthop 55(1):135–141. https://doi.org/10.1007/s43465-020-00244-xCrossRefPubMedPubMedCentral

26.

Flückiger G, Weber M (2005) The transfibular approach for ankle arthrodesis. Operative Orthopadie und Traumatologie 17(4–5):361–379. https://doi.org/10.1007/s00064-005-1148-9CrossRefPubMed

27.

Lee DY, Kyung MG, Cho YJ, Hwang S, Kang HW, Lee DO (2020) A modified transfibular technique of ankle arthrodesis using partial fibular resection and onlay bone graft. PLoS ONE 15(10):e0241141. https://doi.org/10.1371/journal.pone.0241141CrossRefPubMedPubMedCentral

28.

Takakura Y, Tanaka Y, Kumai T, Tamai S (1995) Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br 77(B1):50–54. https://doi.org/10.1302/0301-620X.77B1.7822395CrossRefPubMed

29.

Terrell RD, Montgomery SR, Pannell WC, Sandlin MI, Inoue H, Wang JC, SooHoo NF (2013) Comparison of practice patterns in total ankle replacement and ankle fusion in the United States. Foot Ankle Int 34(11):1486–1492. https://doi.org/10.1177/1071100713494380CrossRefPubMed

30.

Suo H, Fu L, Liang H, Wang Z, Men J, Feng W (2020) End-stage ankle arthritis treated by ankle arthrodesis with screw fixation through the transfibular approach: a retrospective analysis. Orthop Surg 12(4):1108–1119. https://doi.org/10.1111/os.12707CrossRefPubMedPubMedCentral

31.

Wang GJ, Shen WJ, McLaughlin RE, Stamp WG (1993) Transfibular compression arthrodesis of the ankle joint. Clin Orthop Relat Res 289:223–227 (PMID: 8472421)CrossRef

32.

Nielsen KK, Linde F, Jensen NC (2008) The outcome of arthroscopic and open surgery ankle arthrodesis: a comparative retrospective study on 107 patients. Foot Ankle Surg 14(3):153–157. https://doi.org/10.1016/j.fas.2008.01.003CrossRefPubMed

33.

Akra GA, Middleton A, Adedapo AO, Port A, Finn P (2010) Outcome of ankle arthrodesis using a transfibular approach. J Foot Ankle Surg 49(6):508–512. https://doi.org/10.1053/j.jfas.2010.07.004CrossRefPubMed

34.

Napiontek M, Jaszczak T (2015) Ankle arthrodesis from lateral transfibular approach: analysis of treatment results of 23 feet treated by the modified Mann’s technique. Eur J Orthop Surg Traumatol 25(7):1195–1199. https://doi.org/10.1007/s00590-015-1663-9CrossRefPubMed

35.

Schmid T, Krause F, Penner MJ, Veljkovic A, Younger ASE, Wing K (2017) Effect of preoperative deformity on arthroscopic and open ankle fusion outcomes. Foot Ankle Int 38(12):1301–1310. https://doi.org/10.1177/1071100717729491CrossRefPubMed

36.

Kumar V, Kar S, Mittal R, Saurabh S, Sharma PK, Meena P (2023) Transfibular ankle arthrodesis with use of sagitally split fibula as a biological plate leads to excellent outcome: a retrospective analysis. J Clin Orthop Trauma 11(38):102–125. https://doi.org/10.1016/j.jcot.2023.102125CrossRef

Title: Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique
Authors: Anton A. Semenistyy
Raytcho I. Kehayov
Publication date: 21-04-2024
Publisher: Springer Paris
Keywords: Osteoarthrosis
Osteoarthrosis
Arthritis
Published in: European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-024-03950-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content