Ankle Arthrodesis 27870

 

synonyms:tibiotalar arthrodesis, tibiotalar fusion, ankle fusion

Ankle Arthrodesis CPT

Ankle Arthrodesis Indications

Ankle Arthrodesis Contraindications

  • Talar AVN (consider Blair technique)
  • Peripheral neuropathy (relative; high nonunion rate; consider AFO/bracing)
  • Severe osteoporosis
  • Infection (consider fusion with external fixation)

Alternatives

  • Conservative care  (NSAIDs, soft-laced ankle gauntlet, AFO)
  • Arthroscopic ankle arthrodesis
  • Ankle arthrodesis in situ

Ankle Arthrodesis Pre-op Planning

  • see (Gougoulias NE, Foot Ankle Int 2007;28:695) for arthroscopic technique
  • For fusion after TAA failure see: (Cuplan P, JBJS 2007;89Br:1178)
  • Can use proximal humeral locking plate (Ahmad J, Foot Ankle Int 2007;28:977)
  • Ankle arthrodesis plates are available from Tournier and .....
  • Screw techniques: Acumed
  • Consider having external fixator available as an alternative if screw fixation is not rigi

Ankle Arthrodesis Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Irrigate.
  • Close in layers.

Ankle Arthrodesis Complications

Ankle Arthrodesis Follow-up care

  • Post-op:bulky Jones dressing with posterior splint and side stirrup.  NWB
  • 7-14 Days:  Wound check, xrays, place in below knee cast.  NWB
  • 6 Weeks: Xray,  evaluate for callus and evaluate patient symptoms.  Place in short leg cast or walking boot.  Generally may gradually begin weight bearing at 7-10 weeks.
  • 3 Months: Begin full weight bearing.  Conitnue walking boot.
  • 4-5 Months: Xray, evaluate for solid fusion.  Discontinue walking boot and return to manual activities when solid union achieved.
  • 1Yr: Xray, outcome evaluation

Ankle Arthrodesis Outcomes

  • >90% fusion rate with arthroscopic ankle arthrodesis (Gougoulias NE, Foot Ankle Int 2007;28:695)
  • (Coester LM, JBJS 83A:219;2001)

Ankle Arthrodesis Review References

  • Coester LM, JBJS 83A:219;2001
  • Zwipp H, Rammelt S, Endres T, Heineck J. High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res. 2010 Apr;468(4):958
  • Abidi NA, JAAOS 2000;8:200
  • Easley ME, Montijo HE, Wilson JB, Fitch RD, Nunley JA 2nd. Revision tibiotalar arthrodesis. JBJS Am. 2008 Jun;90(6):1212-23.
  • Plaass C, Knupp M, Barg A, Hintermann B. Anterior double plating for rigid fixation of isolated tibiotalar arthrodesis. Foot Ankle Int. 2009 Jul;30(7):631-9.
  • Levine SE, Myerson MS, Lucas P, Schon LC. Salvage of pseudoarthrosis after tibiotalar arthrodesis. Foot Ankle Int. 1997 Sep;18(9):580-5.
  • Colman AB, Pomeroy GC. Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome. Foot Ankle Int. 2007 Mar;28(3):303-7.
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