position
Ankle Arthrodesis
Results
90% fusion rates
Lose70% sagittal plane ROM
Disadvantages of Arthrodesis
Non union rates up to 12%
Decreased gait speed
Poor mobility over uneven surfaces
Osteoarthritis
Epidemiology
Male & Females > 60 years
- X-ray evidence of OA
Symptomatic
- 25% females
- 15% males
Affected joints
Base thumb
PIPJ / Bouchard's nodes
DIPJ / Heberden's nodes
Arthrodesis
Indications
Very few
- young labourer with severe disabling elbow pain
- trial in POP at 90o for 6 weeks
Poor function
- adjacent joints cannot compensate for loss of function
Contraindications
RA
- high failure rate especially flail elbow with poor bone stock
Arthrodesis
Indications
Young adult
- 16 - 30 years old
- monoarticular disease
- heavy demand
Exhausted options of osteotomy
- risk of THA failure / multiple revision surgeries considered too high
Aims of arthrodesis
Maximise bony contact
Minimise shortening
Arthroscopy
Indication
Diagnostic
Pain / Stiffness / Locking
Instability
- exclude OCD
Assess syndesmosis
Therapeutic
Synovitis
Osseous lesions / Tibiotalar impingement spurs
Osteochondral defects
Smith Robinson Approach
Via the carotid triangle
SCM / posterior belly digastric / superior belly omohyoid
Indication
Exposes inferior body C2 - T1
Position
1. Supine in tongs
2. Sit on head board with head taped and slightly extended
Table 30° up
Turn head away from side of incision
Which Side