Tibiotalocalcaneal arthrodesis via lateral transfibular approach to treat tibiotalar and subtalar arthropathy / 中华骨科杂志

ABSTRACT

Objective To observe operative results of tibiotalocalcaneal arthrodesis (TTC) via lateral transfibular approach in the treatment of severe ankle and subtalar diseases.Methods Eighteen patients treated with TTC via lateral transfibular approach from January 2015 to December 2017 were retrospectively analyzed.There were 11 males and 7 females from 39 to 76 years old,with an average age of 53.4 years.Preoperative diagnoses included traumatic arthritis (3 cases),osteoarthritis (10 cases),talar necrosis (3 cases),failure of ankle fusion (1 case) and Charcot-Marie-Tooth disease (1 case).Ankle and hindfoot deformity included varus (10 cases),valgus (6 cases),equinus (1 case) and equinovarus (1 case).All cases were classified into stage-3 arthritis according to Morrey-Wiedeman classification.All patients sustained pain and stiffness in the ankle and hindfoot as well as walking dysfunction.Preoperative and 1 year postoperative visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were collected.Postoperative joint fusion and complications were observed.Results Follow-up ranged from 12-47 months,averaging 25.4 months.Preoperative VAS scores were 6-9,averaging 7.1 ± 1.0,while postoperative VAS scores at 1 year follow-up were 0-2,averaging 0.9±0.8,which decreased significantly.Preoperative AOFAS scores were 24-59,averaging 40.6± 11.5,while postoperative AOFAS scores at 1 year follow-up were 68-84,averaging 75.3±5.8,which increased significantly.8 cases were good and 10 cases were fair according to AOFAS scores at 1 year follow-up.The excellent and good rate was 44.4％ (8/18).All joints were fused successfully without implants loosening or breakage.All patients satisfied with operative results at 1 year follow-up.Lateral distal wound dehiscence happened in l case of traumatic arthritis and the wound was finally healed after debridement and vacuum assisted closure (VAC).Two cases of osteoarthritis presented with dorsal lateral foot numbness and became asymptomatic after neurotrophic medication.One case of osteoarthritis complained of discomfort in the lateral heel caused by implants prominence and implants were removed at 1 year after surgery.Postoperative complication rate was 22.2％(4/18).Conclusion TTC via lateral transfibular approach with cannulated screws and locking plate system is safe and effective.Joint fusion rate is high and complication rate is low.During operation,attention should be paid to restoring hindfoot alignment,soft tissue balance,proper bone graft and joint compression.