Arthrodesis is one of the methods for treating advanced stages of the ankle joint deforming arthrosis. A distinctive feature of this operation is the variability of bone fragments fixation. There are various options for arthrodesis, but they are mainly divided into internal and external fixation. Moreover, the increasing popularity of arthroscopic arthrodesis technology and ankle arthroplasty developments have opened new possibilities for doctors but have also posed new challenges. Aim. To evaluate treatment options for ankle arthrosis of various etiologies and provide recommendations for clinical improvement. To give a prospective analysis of technology development. Clinical outcomes of arthroplasty, arthrodesis, and arthroscopy were not significantly different. Patients with endoprosthesis had significantly more frequent reoperations. Conclusion. In arthrodesis with the Ilizarov apparatus, there are more advantages due to variability and many modifications, and the scope of internal fixation expands. There is disagreement over the optimal choice of internal fixation for arthrodesis. The choice is determined by factors such as the patient’s condition and the doctor’s preferences. In uncomplicated ankle osteoarthritis, an antegrade intramedullary pin is preferred over a retrograde pin. Ankle joint arthroscopy has technical advantages, and its use in severe joint deformities has become a direction for future research. The results obtained can be applied in the motor rehabilitation of patients after arthrodesis. Arthroscopy and arthrodesis are the most promising for postoperative motor rehabilitation of patients compared to endoprosthetisc.
arthrodesis, ankle joint, external fixation, internal fixation, arthroscopy, prosthetics, motor rehabilitation
1. Baker M.J., Offut S.M. External fixation: indications and patient selection. Clinics in Podiatric Medicine and Surgery. 2003; (20): 9-26.
2. Fomichev V.A., Sorokin E.P., Chugaev D.V., Konoval'chuk N.S., Lasunskiy S.A. Artrodezirovanie golenostopnogo sustava kak optimal'naya hirurgicheskaya opciya pri lechenii pacientov s deformiruyuschim artrozom golenostopnogo sustava terminal'noy stadii (obzor literatury). Kafedra travmatologii i ortopedii. 2019; (4): 18-26. https://doi.org/10.17238/issn2226-2016.2019.4.18-26
3. Dhillon M.S., Hooda A., Kumar P. History of foot and ankle arthroscopy. Journal of Arthroscopic Surgery and Sports Medicine. 2020; (1): 126-132. https://doi.org/10.25259/JASSM_4_2020
4. Stavrakis A.I., SooHoo N.F. Trends in complication rates following ankle arthrodesis and total ankle replacement. The Journal of Bone and Joint Surgery. 2016; (98): 1453-1458. https://doi.org/10.2106/JBJS.15.01341
5. Yousry A.H., Abdaihady A.M. Management of diabetic neuropathic ankle arthropathy by arthrodesis using an Ilizarov frame. Acta Orthopaedica Belgica. 2010; 7(6): 821-826.
6. El-Gafary K.A., Mostafa K.M., Al-Adly W.Y. The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results. The Journal of Bone and Joint Surgery, British Volume. 2009; (91): 1322-1325. https://doi.org/10.1302/0301-620X.91B10.22431
7. El-Alfy B. Arthrodesis of the ankle joint by Ilizarov external fixator in patients with infection or poor bone stock. Foot and Ankle Surgery. 2010; (16): 96-100. https://doi.org/10.1016/j.fas.2009.06.004
8. Gessmann J., Ozokyay L., Fehmer T., Muhr G., Seybold D. Arthrodesis of the infected ankle joint: results with the Ilizarov external fixator. Zeitschrift fur Orthopadie und Unfallchirurgie. 2010; (149): 212-218. https://doi.org/10.1055/s-0030-1250360
9. Karapinar H., Sener M., Kazimoglu C., Akgun U. Arthrodesis of neuropathic ankle joint by Ilizarov fixator in diabetic patients. Journal of the American Podiatric Medical Association. 2009; (99): 42-48. https://doi.org/10.7547/0980042
10. Plakseychuk Yu.A., Salihov R.Z., Solov'ev V.V. Sovremennye metody lecheniya avaskulyarnogo nekroza tarannoy kosti i ih rezul'taty. Prakticheskaya medicina. 2011; (55): 98-101.
11. Kenzora J.E., Simmons S.C., Burgess A.R., Edwards C.C. External fixation arthrodesis of the ankle joint following trauma. Foot & Ankle. 1986; (7): 49-61. https://doi.org/10.1177/107110078600700108
12. Malarkey R.F., Binski J.C. Ankle arthrodesis with the Calandruccio frame and bimalleolar onlay grafting. Clinical Orthopaedics and Related Research. 1991; (268): 44-48.
13. Thiryayi W.A., Naqui Z., Khan S.A. Use of the Taylor spatial frame in compression arthrodesis of the ankle: a study of 10 cases. The Journal of Foot and Ankle Surgery. 2010; 49(2): 182-187. https://doi.org/10.1053/j.jfas.2009.05.015
14. Kiene J., Schulz A.P., Hillbricht S., Jürgens C., Paech A. Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases. European Journal of Medical Research. 2009; 14(1): 25-29. https://doi.org/10.1186/2047-783x-14-1-25
15. Bek D., Demiralp B., Kürklü M., Ateşşalp A.S., Başşbozkurt M. Ankle arthrodesis using an Ilizarov external fixator in patients wounded by landmines and gunshots. Foot & Ankle International. 2008; 29(2): 178-184. https://doi.org/10.3113/FAI.2008.0178
16. Plakseychuk Yu.A., Salihov R.Z., Solov'ev V.V. Hirurgicheskoe lechenie bol'nyh s artrozom golenostopnogo sustava. Kazanskiy medicinskiy zhurnal. 2012; 93(1): 38-43.
17. Torudom Y. The results of ankle arthrodesis with screws for end stage ankle arthrosis. Journal of the Medical Association of Thailand. 2010; 93(2): S50-54.
18. Zwipp H., Rammelt S., Endres T., Heineck J. High union rates and function scores at midterm followup with ankle arthrodesis using a four-screw technique. Clinical Orthopaedics and Related Research. 2010; 468(4): 958-968. https://doi.org/10.1007/s11999-009-1074-5
19. Klouche S., El-Masri F., Graff W., Mamoudy P. Arthrodesis with internal fixation of the infected ankle. The Journal of Foot and Ankle Surgery. 2011; 50(1): 25-30. https://doi.org/10.1053/j.jfas.2010.10.011
20. Fujimori J., Yoshino S., Koiwa M., Nakamura H., Shiga H., Nagashima S. Ankle arthrodesis in rheumatoid arthritis using an intramedullary nail with fins. Foot & Ankle International. 1999; 20(8): 485-490. https://doi.org/10.1177/107110079902000804
21. Takenouchi K., Morishita M., Saitoh K., Wauke K., Takahashi H., Nagashima M. Long-term results of ankle arthrodesis using an intramedullary nail with fins in patients with rheumatoid arthritis hindfoot deformity. Journal of Nippon Medical School. 2009; 76(5): 240-246. https://doi.org/10.1272/jnms.76.240
22. Bakir R.A., Logunov A.L., Makarov S.A., Pavlov V.P. Artrodez golenostopnogo i taranno-pyatochnogo sustavov u bol'nyh revmatoidnym artritom. Nauchno-prakticheskaya revmatologiya. 2012; 4(53): 98-99.
23. Moore T.J., Prince R., Pochatko D., Smith J.W., Fleming S. Retrograde intramedullary nailing for ankle arthrodesis. Foot & Ankle International. 1995; 16(7): 433-436. https://doi.org/10.1177/107110079501600710
24. Paola L.D., Volpe A., Varotto D., Postorino A., Brocco E., Senesi A., Merico M., Vido De D., Da Ros R., Assaloni R. Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure. Foot & Ankle International. 2007; 28(9): 967-970. https://doi.org/10.3113/FAI.2007.0967
25. Pinzur M.S., Noonan T. Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. Foot & Ankle International. 2005; 26(7): 545- 549. https://doi.org/10.1177/107110070502600709
26. Mückley T., Klos K., Drechsel T., Beimel C., Gras F., Hofmann G.O. Short-term outcome of retrograde tibiotalocalcaneal arthrodesis with a curved intramedullary nail. Foot & Ankle International. 2011; 32(1): 47-56. https://doi.org/10.3113/FAI.2011.0047
27. Saakyan S.V., Myakoshina E.B., Yurovskaya N.N. Distantnaya opuholeassociirovannaya makulopatiya pri nachal'noy melanome horioidei. Rossiyskiy Oftal'mologicheskiy Zhurnal. 2011; 4(2): 41-45.
28. Myerson M.S., Quill G. Ankle arthrodesis. A comparison of an arthroscopic and an open method of treatment. Clinical Orthopaedics and Related Research. 1991; (268): 84-95.
29. Slivkov K.A., Brizhan' L.K., Davydov D.V., Kerimov A.A., Aseeva I.A. Hirurgicheskie oslozhneniya posle artrodeza golenostopnogo sustava. Medicinskiy sovet. 2013; (4-2): 96-99.
30. Hominec V.V., Mihaylov S.V., Shakun D.A., Zhumagaziev S.E., Komarov A.V. Artrodezirovanie golenostopnogo sustava s ispol'zovaniem treh spongioznyh vintov. Travmatologiya i ortopediya Rossii. 2018; 24(2): 117-126. https://doi.org/10.21823/2311-2905-2018-24-2-117-126
31. Coester L.M., Saltzman C.L., Leupold J., Pontarelli W. Long-term results following ankle arthrodesis for post-traumatic arthritis. The Journal of Bone and Joint Surgery. 2001; 83(2): 219-28. https://doi.org/10.2106/00004623-200102000-00009
32. Mazur J.M., Schwartz E., Simon S.R. Ankle arthrodesis. Long-term follow-up with gait analysis. The Journal of Bone and Joint Surgery American Volume. 1979; 61(7): 964-975.
33. Henricson A., Jehpsson L., Carlsson A., Rosengren B.E. Re-arthrodesis after primary ankle fusion: 134/1,716 cases fr om the Swedish Ankle Registry. Acta Orthopaedica. 2018; 89(5): 560-564. https://doi.org/10.1080/17453674.2018.1488208
34. Lidor C., Ferris L.R., Hall R., Alexander I.J., Nunley J.A. Stress fracture of the tibia after arthrodesis of the ankle or the hindfoot. The Journal of Bone and Joint Surgery. 1997; 79(4): 558-564.
35. Fedorov V.G. Artrodez golenostopnogo sustava pri revmatoidnom artrite. Nauchno-prakticheskaya revmatologiya. 2011; (1): 75-77.
36. Jeng C.L., Baumbach S.F., Campbell J., Kalesan B., Myerson M.S. Comparison of initial compression of the medial, lateral, and posterior screws in an ankle fusion construct. Foot & Ankle International. 2011; (32): 71-76. https://doi.org/10.3113/FAI.2011.0071
37. Obolenskiy V.N., Procko V.G. Pyatochno-bol'shebercovyy artrodez v hirurgicheskoy taktike lecheniya stopy Sharko s porazheniem golenostopnogo sustava. Rany i ranevye infekcii. Zhurnal imeni professora B.M. Kostyuchenka. 2019; 6(1): 13-24. https://doi.org/10.25199/2408-9613-2018-6-1-13-24
38. Zarutsky E., Rush S.M., Schuberth J.M. The use of circular wire external fixation in the treatment of salvage ankle arthrodesis. The Journal of Foot and Ankle Surgery. 2005; (44): 22-31. https://doi.org/10.1053/j.jfas.2004.11.004
39. Pickering R.M. Arthrodesis of ankle, knee, and hip. Campbell’s Operative Orthopaedics. Mosby, St. Louis. 163-207. Available at: https://www.hanspub.org/reference/ReferencePapers.aspx?ReferenceID=111575 (data obrascheniya 07.04.2022)
40. Veljkovic A.N., Daniels T.R., Glazebrook M.A., Dryden P.J., Penner M.J., Wing K.J., Younger A.S.E. Outcomes of total ankle replacement, arthroscopic ankle arthrodesis, and open ankle arthrodesis for isolated non-deformed end-stage ankle arthritis. The Journal of Bone and Joint Surgery. 2019; 101(17): 1523-1529. https://doi.org/10.2106/JBJS.18.01012
41. Norvell D.C., Ledoux W.R., Shofer J.B., Hansen S.T., Davitt J., Anderson J.G., Bohay D., Coetzee J.C., Maskill J., Brage M., Houghton M., Sangeor- zan B.J. Effectiveness and safety of ankle arthrodesis versus arthroplasty: A prospective multicenter study. The Journal of Bone and Joint Surgery. American Volume. 2019. 101(16): 1485-1494. https://doi.org/10.2106/JBJS.18.01257
42. Brodsky J.W., Kane J.M., Coleman S., Bariteau J., Tenenbaum S. Abnormalities of gait caused by ankle arthritis are improved by ankle arthrodesis. The Bone & Joint Journal. 2016; 98B(10): 1369-1375. https://doi.org/10.1302/0301-620X.98B10.37614
43. Haddad S.L., Coetzee J.C., Estok R., Fahrbach K., Banel D., Nalysnyk L. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. The Journal of Bone and Joint Surgery. 2007; 89(9): 1899-1905. https://doi.org/10.2106/JBJS.F.01149
44. Hahn M.E., Wright E.S., Segal A.D., Orendurff M.S., Ledoux W.R., Sangeorzan B.J. Comparative gait analysis of ankle arthrodesis and arthroplasty: Initial findings of a prospective study. Foot & Ankle International. 2012; 33(4): 282-289. https://doi.org/10.3113/FAI.2012.0282
45. Caravaggi P., Lullini G., Leardini A., Berti L., Vannini F., Giannini S. Functional and clinical evaluation at 5-year follow-up of a three-component prosthesis and osteochondral allograft transplantation for total ankle replacement. Clinical Biomechanics. 2015; 30(1): 59-65. https://doi.org/10.1016/j.clinbiomech.2014.11.003
46. Pinsker E., Inrig T., Daniels T.R., Warmington K., Beaton D.E. Symptom resolution and patient-perceived recovery following ankle arthroplasty and arthrodesis. Foot & Ankle International. 2016; 37(12): 1269-1276. https://doi.org/10.1177/1071100716660820
47. Flavin R., Coleman S.C., Tenenbaum S., Brodsky J.W. Comparison of gait after total ankle arthroplasty and ankle arthrodesis. Foot & Ankle International. 2013; 34(10): 1340-1348. https://doi.org/10.1177/1071100713490675
48. Pagenstert G.I., Hintermann B., Barg A., Leumann A., Valderrabano V. Realignment surgery as alternative treatment of varus and valgus ankle osteoarthritis. Clinical Orthopaedics and Related Research. 2007; (462): 156-168. https://doi.org/10.1097/BLO.0b013e318124a462
49. van den Boom N.A.C., Stollenwerck G.A.N.L., Evers S.M.A.A., Poeze M. Effectiveness and cost-effectiveness of primary arthrodesis versus open reduction and internal fixation in patients with Lisfranc fracture instability (The BFF Study) study protocol for a multicenter randomized controlled trial. BMC Surgery. 2021; 21(1): 1-11. https://doi.org/10.1186/s12893-021-01320-1
50. van den Boom N.A.C., Stollenwerck G.A., Lodewijks L., Bransen J., Evers S.M., Poeze M. Lisfranc injuries: fix or fuse? a systematic review and meta-analysis of current literature presenting outcome after surgical treatment for Lisfranc injuries. Bone & Joint Open. 2021; 2(10): 842-849. https://doi.org/10.1302/2633-1462.210.BJO-2021-0127.R1
51. Kandil M.I., Abouzeid M., Eltaher S.M., Eltregy S. Primary fusion versus open reduction internal fixation for purely ligamentous lisfranc injuries: A Prospective comparative study and analysis of factors affecting the outcomes. Foot and Ankle Surgery. 2021. https://doi.org/10.1016/j.fas.2021.12.006
52. Godoy-Santos A.L., de Cesar Netto C. Primary Arthrodesis for High-Energy Lisfranc Injuries. Foot and Ankle Clinics. 2020; 25(4): 727-736. https://doi.org/10.1016/j.fcl.2020.08.010
53. Laffont I. 2019 Sidney Licht lecture: Spasticity and related neuro-orthopedic deformities: A core topic in physical and rehabilitation medicine. The Journal of the International Society of Physical and Rehabilitation Medicine. 2021; 4(2): 51-57. https://doi.org/10.4103/JISPRM-000080
54. Lorentzen J., Pradines M., Gracies J.M., Nielsen J.B. On Denny-Brown’s ‘spastic dystonia’-What is it and what causes it? Clinical Neurophysiology. 2018; 129(1): 89-94. https://doi.org/10.1016/j.clinph.2017.10.023
55. Chalard A., Amarantini D., Tisseyre J., Marque P., Tallet J., Gasq D. Spastic co-contraction, rather that spasticity, is associated with impaired active function in adults with acquired brain injury: A pilot study. Journal of Rehabilitation Medicine. 2019; 51(4): 307-311. https://doi.org/10.2340/16501977-2528
56. Dehail P., Gaudreault N., Zhou H., Cressot V., Martineau A., Kirouac-Laplante J., Trudel G. Joint contractures and acquired deforming hypertonia in older people: Which determinants? Annals of Physical and Rehabilitation Medicine. 2019; 62(6): 435-441. https://doi.org/10.1016/j.rehab.2018.10.005
57. Kuo C.L., Hu G.C. Post-stroke spasticity: a review of epidemiology, pathophysiology, and treatments. International Journal of Gerontology. 2018; 12(4): 280-284. https://doi.org/10.1016/j.ijge.2018.05.005
58. Pérennou D., Bensmail D., Laffont I., Marque P., Yelnik A. A century of research on spasticity: Editors’ opinion. Annals of Physical and Rehabilitation Medicine. 2019; 62(6): 393-396. https://doi.org/10.1016/j.rehab.2019.11.001
59. European Physical and Rehabilitation Medicine Bodies Alliance. White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 4. History of the specialty: wh ere PRM comes from. European Journal of Physical and Rehabilitation Medicine. 2018; 54(2): 186-197. https://doi.org/10.23736/s1973-9087.18.05147-x
60. Hernigou P., Gravina N., Potage D., Dubory A. History of club-foot treatment; part II: tenotomy in the nineteenth century. International Orthopaedics. 2017; 41(10): 2205-2212. https://doi.org/10.1007/s00264-017-3578-z
