ARTHROSCOPIC TIBIOTALAR ARTHRODESIS: RESULTS IN 16 CASES

Abstract

Purpose: Indications for tibiotalar arthrodesis persist in patients with septic or inflammatory joint disease. Arthroscopic arthrodesis can be used to limit immediate postoperative morbidity. This technique has been used in our unit since 1994. The purpose of this work was to assess long-term outcome and specific complications.

Material and methods: All patients who underwent arthroscopic tibiotalar arthrodesis since 1994 (16 patients) were reviewed by an independent observer. There were nine women and seven men, mean age 56 years (37–81). The cause of the tibiotalar disease was post-traumatic degeneration in 12 cases, primary osteoarthritis in two and rheumatoid polyarthritis in two. The ankle was centred preoperatively in all cases. Osteosynthesis was achieved with screw fixation in 14 cases and with an external fixator in two. Mean follow-up was 43.4 months (6–80 months). Outcome was assessed on the basis of delay to fusion, presence of residual pain, and complications induced by the technique.

Results: Mean hospital stay was five days (3–11 days). There was no infectious or cutaneous complication. Three patients had a sensorial deficit in the territory of the superficial fibular nerve. Fusion was obtained in all patients. Mean delay to fusion was 3.4 months (range 2–7.5 months). All patients except one who had a painful fibulotalar non-union could walk without pain after fusion had been achieved.

Discussion: Arthroscopic tibiotalar arthrodesisis a reliable procedure for the treatment of destroyed joints after centring the ankle. We were satisfied with the results of percutaneous screw fixation. Delay to fusion was comparable with delays observed after open procedures and complication rate was lower.

Conclusion: Since the postoperative morbidity is low and long-term results are equivalent, we propose arthroscopic arthrodesis for the treatment of tibiotalar destruction.