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Revision tibiotalar arthrodesis.

Publication ,  Journal Article
Easley, ME; Montijo, HE; Wilson, JB; Fitch, RD; Nunley, JA
Published in: J Bone Joint Surg Am
June 2008

BACKGROUND: Contemporary recommendations for primary and revision ankle arthrodesis favor internal compression techniques involving the use of screw and/or plate fixation. While tibiotalocalcaneal arthrodesis with internal fixation may be a suitable method of salvage for the treatment of a failed tibiotalar arthrodesis in selected patients, ring external fixation has been reported as an alternative. We reviewed our experience with revision tibiotalar arthrodesis, with a focus on ring external fixation. METHODS: Forty-five consecutive patients underwent revision tibiotalar arthrodesis with use of repeat internal fixation (eleven patients), ring external fixation (twenty-two patients), or tibiotalocalcaneal arthrodesis (twelve patients). Union rates were assessed radiographically, and functional outcome was determined with use of preoperative and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scores. RESULTS: All forty-five patients were available for follow-up at an average of 50.3 months. The average ankle-hindfoot score improved from 31.1 points preoperatively to 65.8 points at the time of the most recent follow-up. At the time of the most recent follow-up, the union rate was 88.9% (forty of forty-five). Fusion was achieved with revision tibiotalar arthrodesis in thirty-six (80%) of forty-five patients, including eight of the eleven patients in the repeat internal fixation group, nineteen of the twenty-two patients in the ring external fixation group, and nine of the twelve patients in the tibiotalocalcaneal arthrodesis group. Re-revision led to union in four of five patients. The overall union rate for ring external fixation, including revision and re-revision tibiotalar arthrodeses, was 84.6% (twenty-two of twenty-six). The five patients with persistent nonunion following revision ankle arthrodesis opted for transtibial amputation. CONCLUSIONS: Revision tibiotalar arthrodesis leads to satisfactory limb salvage in a majority of patients. Ring external fixation may facilitate clinically acceptable limb salvage in complex cases when methods of internal fixation are limited or even contraindicated.

Duke Scholars

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

June 2008

Volume

90

Issue

6

Start / End Page

1212 / 1223

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tibia
  • Subtalar Joint
  • Reoperation
  • Radiography
  • Postoperative Complications
  • Orthopedics
  • Orthopedic Fixation Devices
  • Male
  • Logistic Models
 

Citation

APA
Chicago
ICMJE
MLA
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Easley, M. E., Montijo, H. E., Wilson, J. B., Fitch, R. D., & Nunley, J. A. (2008). Revision tibiotalar arthrodesis. J Bone Joint Surg Am, 90(6), 1212–1223. https://doi.org/10.2106/JBJS.G.00506
Easley, Mark E., Harvey E. Montijo, Joseph B. Wilson, Robert D. Fitch, and James A. Nunley. “Revision tibiotalar arthrodesis.J Bone Joint Surg Am 90, no. 6 (June 2008): 1212–23. https://doi.org/10.2106/JBJS.G.00506.
Easley ME, Montijo HE, Wilson JB, Fitch RD, Nunley JA. Revision tibiotalar arthrodesis. J Bone Joint Surg Am. 2008 Jun;90(6):1212–23.
Easley, Mark E., et al. “Revision tibiotalar arthrodesis.J Bone Joint Surg Am, vol. 90, no. 6, June 2008, pp. 1212–23. Pubmed, doi:10.2106/JBJS.G.00506.
Easley ME, Montijo HE, Wilson JB, Fitch RD, Nunley JA. Revision tibiotalar arthrodesis. J Bone Joint Surg Am. 2008 Jun;90(6):1212–1223.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

June 2008

Volume

90

Issue

6

Start / End Page

1212 / 1223

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tibia
  • Subtalar Joint
  • Reoperation
  • Radiography
  • Postoperative Complications
  • Orthopedics
  • Orthopedic Fixation Devices
  • Male
  • Logistic Models