Early weight bearing is safe following arthroscopic ankle arthrodesis

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Abstract

Rehabilitation regimes following arthroscopic ankle arthrodesis vary widely. This study was conducted to determine whether it is safe to allow early weight bearing following arthrodesis by analysing results before and after changes in the practice of one surgeon. Two groups of comparable patient populations were compared; Group 1 (15 patients) in whom weight bearing was restricted; Group 2 (21 patients) who were encouraged to weight bear in the early postoperative period. All patients had an arthroscopic arthrodesis secured with two medial compression screws. The extent and progression of union was determined at 2 and 4 months. There was 100% union in both groups by 4 months with no difference in extent of union at 2 months. The most common complication (15%) was the requirement for later screw removal. The results suggest that it is safe to mobilise patients fully weight bearing in the early postoperative period following arthroscopic ankle arthrodesis.

Introduction

Arthroscopic ankle arthrodesis is an acceptable alternative to open ankle arthrodesis as a technique in treating osteoarthritic (OA) ankle joints [1], [2], [3]. Many authors note the reduced rehabilitation times of arthroscopic over open fusions [1], [3], [4], [5], [6]. There is, however, little uniformity in postoperative mobilising regimens (Table 1). Most authors immobilise the foot and ankle in a rigid cast and restrict weight bearing for many weeks.

The senior author (PHC) has been performing arthroscopic ankle arthrodeses in excess of 7 years. He has changed his rehabilitation protocols in favour of early weight bearing in removable thermoplastic (TP) splints based on observation of patients, who despite being unable to restrict their weight bearing, united satisfactorily. In order to test his theory that early weight bearing was acceptable, an analysis of two groups of patients was performed. One group was from relatively early in his experience in whom weight bearing was restricted and one, more recent group where weight bearing was encouraged. The Null hypothesis is that no difference exists between the groups with regards to non-union rates and times to union.

Section snippets

Methods

A retrospective analysis of patient records and radiographs was conducted of (National Health Service) patients who underwent arthroscopic ankle arthrodesis under a single surgeon (PHC). Two groups were analysed and compared. Group 1 (restricted weight bearing) had their operations during 1998 and 1999 and Group 2 (unrestricted weight bearing) during 2002.

There were 16 patients in Group 1 and 23 in Group 2. The notes for all patients in each group were located but the postoperative radiographs

Results

The postoperative weight bearing instructions, union rates and time at which union was declared for each patient is shown in Table 3 for Group 1 patients and Table 4 for Group 2 patients.

Of the 15 Group 1 and 21 Group 2 patients who had postoperative radiographs available, all had united by the second review (at a mean of 4 months postoperatively). Signs of clinically significant union were present in 12 of 15 (80%) patients in Group 1 and in 16 of 21 (76%) in Group 2 at the first review (at a

Discussion

Arthroscopic ankle arthrodesis is a reliable technique of achieving ankle fusion. We achieved 100% fusion in both study groups within 4 months. The two study groups were similar in terms of patient demographics, the aetiology of arthrosis and degree of deformity in the AP plane (Table 2). The first group of patients were selected from a time period well after the senior surgeon (PHC) began to employ this technique. This was in order to reduce the effect that a ‘learning curve’ would have on the

Conclusions

Based on our observations, we feel justified in our practice of early weight bearing in uncomplicated cases following arthroscopic ankle arthrodesis. The time to bony union remains predictable and patient satisfaction is high.

References (15)

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