ANTERIOR T-PLATE FOR ANKLE ARTHRODESIS

Abstract

Introduction: The long term results of Total Ankle Arthroplasty still remain largely unsatisfactory and Ankle Arthrodesis remains the gold standard treatment for severe degenerative ankle joint disease resulting from trauma and other causes. We describe the method and results of ankle fusion performed with a single anterior midline incision using the standard AO T-Plate.

Material and Methods: 18 patients underwent fusion of the tibiotalar joint with this technique over the past 6 years with a follow up range of 10 months to 5 years (mean-19 months). Though the commonest indication was post-traumatic degenerative joint disease (this included 6 patients who had previous internal fixation), other causes included primary osteoarthritis, rheumatoid arthritis, neuropathic joint (Charcot’s) and failed arthrodesis with other methods. The mean age was 65.5 yrs (range 37–91). The patients were assessed clinically and radiologically.

Results: There was radiological union in all 18 patients. Excellent clinical results were finally achieved in 16 (89%). Complications included persistent pain(1), delayed union(2), infection(2, including one deep) and 2 underwent removal of plate with good final result.

Discussion: This technique is a modification of that described previously by Rowan and Davey. In our practice the plate is contoured to the surface of talus and distal screws are directed more vertically towards the sustenaculum talus. We found it helpful to obtain more compression of adjacent surfaces.

Conclusion: With the use of an anterior T-plate not only a better stability in biomechanical terms is achieved, better soft tissue cover of the metalwork help in overall patient satisfaction. Though we have performed ankle arthrodesis with different methods with satisfactory results, with this particular technique we have achieved excellent results and radiological union in all patients.