Early weight bearing is safe 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.
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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)
- et al.
Analysis of arthroscopically assisted ankle arthrodesis
Arthroscopy
(2002) Arthroscopic arthodesis of the ankle, subtalar and first metatarsophalangeal joint
Foot Ankle Clin
(2002)- et al.
Ankle arthrodesis using an arthroscopic method: long-term follow-up of 34 cases
Arthroscopy
(1996) - et al.
Ankle arthrodesis: a comparison of an arthroscopic and an open method of treatment
Clin Orthop
(1991) - et al.
Open versus arthroscopic ankle arthrodesis: a comparative study
Foot Ankle Int
(1999) - et al.
Arthroscopically assisted arthrodesis for osteoarthrotic ankles
JBJS
(1993) - et al.
Cigarette smoking and non-union after ankle arthrodesis
Foot Ankle Int
(1994)
Cited by (20)
Current concepts for arthroscopic ankle fusion
2021, Journal of Arthroscopy and Joint SurgeryCitation Excerpt :Traditionally, patients are kept non-weightbearing after an AAA for 6 weeks, followed by weight bearing in plaster cast, with the total duration in plaster being 3 months. Cannon et al.34 however allowed patients without any peripheral neuropathy or pre-operative talar collapse, to fully weight bear as tolerated from day 1 following surgery, and did not find a detrimental effect on their outcomes. Ankle arthrodesis provides significant pain relief and improvement in quality of life, as demonstrated by the improvement seen in patient reported outcome measures (PROMs) such as the ankle osteoarthritis scale (AOS), short form – 36 (SF-36), physical component summary (PCS) and foot and ankle ability measure (FAAM).35,36
Arthroscopic versus open ankle arthrodesis
2018, Foot and Ankle SurgeryCitation Excerpt :Finally, although post-operative regimes were not standardised, early weight bearing is commonly practiced by many surgeons [1]. Cannon et al. [10] also demonstrated that early weight bearing did not affect fusion rates providing it was protected in a splint. We made every effort to limit these weaknesses.
Arthroscopic assisted ankle arthrodesis - A systematic overview
2014, Fuss und SprunggelenkHeadless compression screw fixation prevents symptomatic metalwork in arthroscopic ankle arthrodesis
2012, Foot and Ankle SurgeryCitation Excerpt :Suggested disadvantages include surgeon learning curve, increased surgical time, and a high rate of re-operation for symptomatic prominence of metalwork. Previous authors had suggested its use only in ankles with minimal deformity [5,6], although subsequent studies have demonstrated the ability to achieve significant deformity correction with the technique [7–9]. Most published methods place at least one cannulated, trans-articular compression screw from proximal/ medial to distal/lateral.
(i) The principles of foot and ankle arthrodesis
2009, Orthopaedics and TraumaCitation Excerpt :Our own regimen for ankle arthrodesis is to allow protected weight-bearing in a cast after 4 weeks, provided the stability of the internal fixation is deemed acceptable. With arthroscopic ankle arthrodesis, earlier weight-bearing has been shown to be safe with no impact on union rates compared to those patients conventionally managed with longer periods of restricted weight-bearing.48 Patients undergoing a subtalar arthrodesis are allowed to fully weight-bear after 2 weeks but are managed in a cast until radiographic union.
Management of the Varus Arthritic Ankle
2008, Foot and Ankle ClinicsCitation Excerpt :Varus positioning also has been shown to be a risk factor for non-union after arthrodesis [22]. A multitude of different ankle arthrodesis techniques have been described, including Dowel arthrodesis [23], inlay grafts [24], onlay grafts [25,26], staples [27], screw fixation [28–31], T-plates [32], angle blade plates [33–35], intramedullary nails [36–38], and external fixation [39,40]—and this list is far from exhaustive! More recently, limited open and arthroscopic techniques have been published [24,41–47].