• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.1-7
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• 2018

Ankle arthrodesis is a common and standard treatment for patients with end-stage ankle arthritis. The surgical goals of ankle arthrodesis are to obtain bony union between the tibia and talus with adequate alignment, and provide a pain-free plantigrade foot for weightbearing activities. To achieve successful fusion, the surgeon should closely examine the patient's factors before surgery, particularly the following: adjacent arthritis and deformity, infection, avascular necrosis of talus, Charcot arthropathy, and rheumatoid arthritis. Recently, ankle arthroplasty has been reported to provide satisfactory clinical results. On the other hand, long-term follow-up results are still lacking, and considering the various complications of arthroplasty, ankle arthrodesis is still the primary surgical treatment for advanced arthritis of the ankle joint.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.111-116
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• 2006

An infection after total knee arthroplasty has many complications such as severe bone defect, skin and soft tissue problems, devastated general condition, so arthrodesis is preferred as treatment option. However, poor bony contact due to severe bone defect and inadequate conditions of the soft tissue often cause nonunion or severe limb shortening after arthrodesis. More over these conditions, it is not easy to choose appropriate fixative devices. In these situations, the arthrodesis using vascularized fibular graft can be the solution. Vascularized fibular graft (VFG) can playa role as a suitable material for the treatment of bone defects. And VFG can overcome poor blood circulation caused by scar tissues, and can be relatively more durable and adequate length. In the long term, VFG can be hypertrophied by weight bearing, and will give mechanical stablility. The purpose of the paper is to report the successful results of arthrodesis using VFG in a patient who got extensive bone defect after failed revision total knee arthroplasty with infection.

• Journal of Korean Foot and Ankle Society
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• v.21 no.1
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• pp.39-42
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• 2017

Surgical treatments for arthritis in the first metatarsophalangeal joint include arthrodesis, interposition arthroplasty using silicone or meniscus cartilage, and rarely arthroplasty. Although arthrodesis was performed successfully, pain can persist if the angle of fusion was inappropriate. Interposition arthroplasty can be tried for the treatment of persisting pain after the arthrodesis. Interposition arthroplasty using tensor fascia lata is known that has low risk of adhesions and easy to harvest. Compared to autologous grafts, grafting rates is high and low risk of rejection additionally. Herein, we report a successfully managed arthritis with severe pain with interposition arthroplasty using tensor fascia lata after a failed metatarsophalangeal joint arthrodesis.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.66-73
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• 2008

Purpose: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. Materials and Methods: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. Results: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. Conclusion: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.47-51
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• 2005

Purpose: We reviewed the results of ankle arthritis with advanced deformity treated with open arthrodesis. Materials and Methods: Seventeen patients who had painful ankle arthritis with advanced deformity underwent open arthrodesis using chevron osteotomy or transfibular approach and were followed for an average of 4.2 years (range, 1.5 to 9.7 years). The average age was 51.4 years and the most common cause was traumatic arthritis (13 patients). Postoperative outcome was evaluated using Mazur's grading system for ankle function. we also checked time to union, patient satisfaction, complications, position of arthrodesis and degenerative changes of adjacent joints. Results: Clinical score was improved to 76.4 points from 46.7 points. Average time to union was 4.3 months and the rate of satisfaction was 88%. Complications included 1 nonunion, 2 malunion, 1 superficial infection and 1 combined delayed union and malunion. There were 14 cases within $5^{\circ}$ valgus in frontal plane and 13 cases within neutral to $5^{\circ}$ dorsiflexion in sagittal plane. 3 cases in chevron osteotomy revealed valgus and plantarflexed position over $5^{\circ}$. Degenerative changes of adjacent joints was seen in 2 patients. Conclusion: Open arthrodesis for ankle arthritis with advanced deformity shows favorable clinical outcome. Transfibular approach shows more consistent results than chevron soteotomy for desired position of arthrodesis.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.19-25
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• 1999

The purpose of this study Is to assess the retained range of motion[RROM] of the foot after arthrodesis of the ankle joint, which might help designing the angle of arthrodesis. We reviewed the results including the RROM in 14 cases of ankle arthrodesis. Underlying causes included trauma group(six posttraumatic arthritis) and disease group(three osteoarthritis, three Charcot joints, one chronic synovitis and one pyogenic arthritis). We measured the RROM on the lateral roentgenograms of the ankle in full dorsiflexion and plantarflexion, The results were assessed by the AOFAS hindfoot scale[score]. The RROM in sagittal plane was $23.4{\pm}5.3$ degrees and the score was 71.5 points on average. The RROM and the score were $26.8^{\circ}{\pm}2.1$, 81.2 points respectively in trauma group and $20.8^{\circ}{\pm}5.6$, 64.3 points in disease group; $26.6^{\circ}{\pm}2.3$, 83.4 points in cases younger than 40 years of age and $21.6^{\circ}{\pm}5.7$, 64.9 points in the older. The mean score was 77.3 points in cases whose RROM were $24^{\circ}$ or more and 61 points in cases of less RROM; 69.6 and 73.4 points in cases with and without adjacent degenerative arthritis respectively. The score was 69.7, 73.3 and 71.5 points in cases whose angle of arthrodesis was in dorsiflexion, neutral, plantarflexion respectively. In conclusion, after ankle arthrodesis RROM of the foot was $23.4^{\circ}$, and the more the RROM, the higher the score. In cases with sufficient amount of RROM, the angle of fusion on sagittal plane might not influence the result significantly.

• Journal of Korean Foot and Ankle Society
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• v.10 no.1
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• pp.66-70
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• 2006

Purpose: To analyze the clinical and radiological outcome of subtalar arthrodesis using cannulated screws and morselized bone graft. Materials and Methods: Twenty one patients with follow-up of more than 1 year after subtalar arthrodesis were included in this study. Mean age was 40.8 years, and mean follow-up duration was 38 months. Underlying diseases were 19 cases of posttraumatic arthritis (18 calcaneal fractures and 1 talar fracture) and 2 cases of tarsal coalition. Clinically AOFAS ankle-hindfoot score, operation time, complication and satisfaction of patients were analyzed. Radiologically time to union, arthritis of surrounding joints, preoperative and postoperative talar declination angle were analyzed. Results: AOFAS ankle-hindfoot score was improved from preoperative 33 points to postooperative 79 points. Eighteen patients (86%) were satisfied with the results. Mean operation time was 91 minutes. All cases were fixed with 1-2 cannulated screws and morselized bone graft. Mean time to radiologic union was 12.1 weeks. There was 1 case of delayed union. There was no significant perioperative changes in talar declination angles. Conclusion: Subtalar arthrodesis using cannulated screws and morselized bone graft seems to be relatively simple and effective treatment method for subtalar arthritis.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.134-138
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• 2000

Arthrodesis of the ankle joint is inevitable in the cases of severe arthrosis or defective bony structures around ankle joint. There have been many kinds of arthrodesis methods were introduced. In cases with failed athrodesis with previous arthrodesis surgery and neuropathic joints have difficulty to achieve fusion of joint with conventional methods. Authors underwent four cases of ankle fusion with vascularized fibular graft from 1997 in the cases of three failed fusions and one diabetic neuropatic joint. Two of four performed free vascularized fibular transplantation from contralateral side leg with microvascular anastomosis, two of four performed with pedicled fibular transposition to the ankle joint in same side leg. Three of four cases achieved arthrodesis average 9.2 months after surgery, one case was failed due to vascular thrombosis of the anastomosed site in diabetic neuropathic condition. The result of this technique revealed 75%(three of four) success rate and longer bone union time required. However, in these cases had no recommendable options with conventional bone graft and additional ankle joint fusions procedure because of poor bone quality and defect of distal tibia and talus portions. Free vascualrized fibular transfer to the failed athrodesis of ankle joint is one of the effective alternative methods in failed ankle fusion cases, especially the quality of the bone around previous fusion site is poor.

• Korean Journal of Veterinary Research
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• v.60 no.4
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• pp.187-194
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• 2020

Two small-breed dogs and two cats, with an average body weight of 4.88 kg (range: 4.3-5.5 kg), suffered hindlimb lameness due to luxation with or without fractures of the tarsocrural joint. These patients underwent tarsocrural arthrodesis with epoxy putty external skeletal fixator. The animals' skins were incised minimally, and the articular cartilage of the tarsocrural joint was removed, followed by autogenous cancellous bone grafting. Epoxy putty and positive Centerface®, pins with diameters 1.2 mm and 2.0 mm, were used for connecting bar and as a full pin fixation, respectively. All the patients regained the ability to bear weight on the affected limb within 3-7 days and resumed a normal gait within 9-15 weeks. The external skeletal fixator frame was removed within 13-17 weeks without major complications. Tarsocrural arthrodesis using epoxy putty external skeletal fixator resulted in excellent outcomes without severe postoperative complications in this study. Epoxy putty external skeletal fixator can be a valuable surgical option for tarsocrural arthrodesis in patients weighing less than 5.5 kg.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.193-196
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• 2005

A posterior 3-portal arthroscopic approach with the patient in the prone position provides a novel and optimal approach for isolated subtalar arthrodesis. This approach facilitates access to the posterior talocalcaneal facet and facilitates safe access with regard to the posteromedial neuromuscular bundle. The technique involves prone positioning, establishment of two posterolateral portals and one posteromedial portal, arthroscopic posterior talocalcaneal facet debridement, percutaneous morcellized bone grafting and internal screw fixation. Preliminary results have shown high patient satisfaction, an excellent fusion rate and less postoperative morbidity than open subtalar arthrodesis.