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Arthrodesen zur Behandlung der Sprunggelenkarthrose

Wann besteht die Indikation zur Versteifung?
  • F. B. Imhoff
  • S. H. Wirth
  • R. S. Camenzind
  • A. F. Viehöfer
  • C. P. LampertEmail author
Leitthema
  • 27 Downloads

Zusammenfassung

Die Arthrodese ist nach wie vor ein Goldstandard in der Behandlung der Arthrose des oberen Sprunggelenks (OSG). Speziell in Fällen mit einer Talusnekrose, großen Knochendefekten der Tibia und ausgeprägten Deformitäten kann nur mit einer Arthrodese ein gutes Resultat erreicht werden. Insbesondere die minimal-invasive Technik mittels Arthroskopie hat das Indikationsspektrum deutlich erweitert. Der Hauptvorteil der Arthrodese ist die sehr hohe Wahrscheinlichkeit der Schmerzfreiheit. Diesbezüglich ist die Arthrodese der Prothese überlegen. Letztlich sind auch die Langzeitergebnisse (über 20 Jahre) ausgezeichnet und werden bisher von der Prothese nicht erreicht. Der Schlüssel zu einem guten Erfolg ist nicht nur die Durchbaurate, sondern vielmehr die ideale Position des Fußes in Relation zur Tibia und zum ganzen Bein. Dieser Beitrag beschreibt detailliert die wichtigen Techniken der OSG-Arthrodese, erklärt deren Vor- und Nachteile und zeigt die wichtigsten Tipps und Tricks, um ein gutes Resultat zu erzielen.

Schlüsselwörter

Minimal-invasive Chirurgie Offene Operation Knochendefekte Schmerzfreiheit Langzeitergebnisse 

Arthrodesis for treatment of osteoarthrosis of the ankle joint

What are the indications for arthrodesis?

Abstract

Arthrodesis of the ankle joint remains a gold standard in the treatment of osteoarthritis of the upper ankle joint. A good result can be achieved only with arthrodesis, especially in cases of talus necrosis, large defects of the tibia and significant deformation. Minimally invasive surgery using arthroscopy, in particular, has greatly increased the spectrum of indications. The main advantage of arthrodesis is the very high probability of painlessness. In this context arthrodesis is superior to a prosthesis. Finally, the long-term results (over 20 years) show excellent outcomes, which have so far not been achieved by prostheses. The key to a successful outcome is not only the bony consolidation rate but also the perfect positioning of the foot in relation to the tibia and to the whole leg. The article describes the important techniques of upper ankle joint arthrodesis in detail, explains the advantages and disadvantages and presents important tips and tricks in order to achieve a successful outcome.

Keywords

Minimally invasive surgery Open surgery Bone defects Painlessness Long-term results 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F.B. Imhoff, S.H. Wirth, R.S. Camenzind, A.F. Viehöfer und C. Lampert geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Anderson T, Montgomery F, Carlsson A (2003) Uncemented STAR total ankle prostheses. Three to eight-year follow-up of fifty-one consecutive ankles. J Bone Joint Surg Am 85-A(7):1321–1329CrossRefGoogle Scholar
  2. 2.
    Barg A, Elsner A, Hefti D, Hintermann B (2010) Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series. Haemophilia 16(4):647–655PubMedGoogle Scholar
  3. 3.
    Baumbach SF, Massen FK, Horterer S et al (2018) Comparison of arthroscopic to open tibiotalocalcaneal arthrodesis in high-risk patients. Foot Ankle Surg.  https://doi.org/10.1016/j.fas.2018.10.006 CrossRefPubMedGoogle Scholar
  4. 4.
    Bernasconi A, Mehdi N, Laborde J et al (2018) Joystick of the talus for correcting malalignment during arthroscopic ankle arthrodesis: a surgical tip. Arthrosc Tech 7:e517–e522CrossRefGoogle Scholar
  5. 5.
    Betz MM, Benninger EE, Favre PP, Wieser KK, Vich MM, Espinosa N (2013) Primary stability and stiffness in ankle arthrodes—Crossed screws versus anterior plating. foot Ankle Surg 19(3):168–172CrossRefGoogle Scholar
  6. 6.
    Brodsky JW, Kane JM, Coleman S et al (2016) Abnormalities of gait caused by ankle arthritis are improved by ankle arthrodesis. Bone Joint J 98-B:1369–1375CrossRefGoogle Scholar
  7. 7.
    Coester LM, Saltzman CL, Leupold J et al (2001) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am 83-A:219–228CrossRefGoogle Scholar
  8. 8.
    Coester LM, Saltzman CL, Leupold J, Pontarelli W (2001) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am 83-A(2):219–228CrossRefGoogle Scholar
  9. 9.
    Dannawi Z, Nawabi DH, Patel A et al (2011) Arthroscopic ankle arthrodesis: are results reproducible irrespective of pre-operative deformity? Foot Ankle Surg 17:294–299CrossRefGoogle Scholar
  10. 10.
    Frey C, Halikus NM, Vu-Rose T, Ebramzadeh E (1994) A review of ankle arthrodesis: predisposing factors to nonunion. Foot Ankle Int 15(11):581–584CrossRefGoogle Scholar
  11. 11.
    Glissan DJ (1949) The indications for inducing fusion at the ankle joint by operation; with description of two successful techniques. Aust N Z J Surg 19(1):64–71CrossRefGoogle Scholar
  12. 12.
    Goetzmann T, Mole D, Jullion S et al (2016) Influence of fixation with two vs. three screws on union of arthroscopic tibio-talar arthrodesis: comparative radiographic study of 111 cases. Orthop Traumatol Surg Res 102:651–656CrossRefGoogle Scholar
  13. 13.
    Hendrickx RPM, De Leeuw PAJ , Golano P et al (2015) Safety and efficiency of posterior arthroscopic ankle arthrodesis. Knee Surg Sports Traumatol Arthrosc 23:2420–2426CrossRefGoogle Scholar
  14. 14.
    Henricson A, Skoog A, Carlsson A (2007) The Swedish Ankle Arthroplasty Register: an analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop 78(5):569–574CrossRefGoogle Scholar
  15. 15.
    Hintermann B, Valderrabano V, Dereymaeker G, Dick W (2004) The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res 424:57–68CrossRefGoogle Scholar
  16. 16.
    Honnenahalli Chandrappa M, Hajibandeh S, Hajibandeh S (2017) Ankle arthrodesis-open versus arthroscopic: a systematic review and meta-analysis. J Clin Orthop Trauma 8:S71–S77CrossRefGoogle Scholar
  17. 17.
    Huang YZ, Zeng XT, Wang J et al (2018) Arthroscopic versus open ankle arthrodesis. Arthroscopy 34:2010CrossRefGoogle Scholar
  18. 18.
    Jones CR, Wong E, Applegate GR et al (2018) Arthroscopic ankle arthrodesis: a 2–15 year follow-up study. Arthroscopy 34:1641–1649CrossRefGoogle Scholar
  19. 19.
    Krause FG, Schmid T (2012) Ankle arthrodesis versus total ankle replacement. How do I decide? Foot Ankle Clin 17(4):529–543CrossRefGoogle Scholar
  20. 20.
    Lattig CFKMS, Lampert C (2003) Does Foot Position in tibiotalar arthrodesis have an effect on the development of secondary arthrosis at long-term follow-up. Foot Ankle Surg 9:25–29Google Scholar
  21. 21.
    De Leeuw PA, Hendrickx RP, Van Dijk CN et al (2016) Midterm results of posterior arthroscopic ankle fusion. Knee Surg Sports Traumatol Arthrosc 24:1326–1331CrossRefGoogle Scholar
  22. 22.
    Ling JS, Orth F, Smyth NA et al (2015) Investigating the relationship between arthritis in the hindfoot A systematic review. J Bone Joint Surg 97(6):513–519, 519aCrossRefGoogle Scholar
  23. 23.
    Malekpour L, Rahali S, Potage D et al (2017) Posterior arthroscopic tibiotalar arthrodesis: anatomic feasibility study. J Foot Ankle Surg 56:704–707CrossRefGoogle Scholar
  24. 24.
    Mitchell PM, Douleh DG, Thomson AB (2017) Comparison of ankle fusion rates with and without anterior plate augmentation. Foot Ankle Int 38(4):419–423CrossRefGoogle Scholar
  25. 25.
    Nakasa T, Ikuta Y, Tsuyuguchi Y et al (2019) Application of a peripheral vein illumination device to reduce saphenous structure injury caused by screw insertion during arthroscopic ankle arthrodesis. J Orthop Sci.  https://doi.org/10.1016/j.jos.2018.12.007 CrossRefPubMedGoogle Scholar
  26. 26.
    Perlman MH, Thordarson DB (1999) Ankle fusion in a high risk population: an assessment of nonunion risk factors. Foot Ankle Int 20(8):491–496CrossRefGoogle Scholar
  27. 27.
    Peterson KS, Lee MS, Buddecke DE (2010) Arthroscopic versus open ankle arthrodesis: a retrospective cost analysis. J Foot Ankle Surg 49:242–247CrossRefGoogle Scholar
  28. 28.
    Prissel MA, Simpson GA, Sutphen SA, Hyer CF, Berlet GC (2017) Ankle Arthrodesis: a retrospective analysis comparing single column, locked anterior plating to crossed lag screw technique. J Foot Ankle Surg 56(3):453–456CrossRefGoogle Scholar
  29. 29.
    Schmid T, Krause F, Penner MJ et al (2017) Effect of preoperative deformity on arthroscopic and open ankle fusion outcomes. Foot Ankle Int 38:1301–1310CrossRefGoogle Scholar
  30. 30.
    Stone JW (2006) Arthroscopic ankle arthrodesis. Foot Ankle Clin 11(2):361–368CrossRefGoogle Scholar
  31. 31.
    Strasser NL, Turner NS (2012) Functional outcomes after ankle arthrodesis in elderly patients. Foot Ankle Int 33(9):699–703CrossRefGoogle Scholar
  32. 32.
    Thomas R, Daniels TR, Parker K (2006a) Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joint Surg Am 88(3):526–535PubMedGoogle Scholar
  33. 33.
    Thomas R, Daniels TR, Parker K (2006b) Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joint Surg Am 88:526–535PubMedGoogle Scholar
  34. 34.
    Thomas R, Daniels TR, Parker K (2006c) Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joint Surg Am 88(3):526–535PubMedGoogle Scholar
  35. 35.
    Townshend D, Di Silvestro M, Krause F et al (2013) Arthroscopic versus open ankle arthrodesis: a multicenter comparative case series. J Bone Joint Surg Am 95:98–102CrossRefGoogle Scholar
  36. 36.
    Yasui Y, Hannon CP, Seow D, Kennedy JG (2016) Ankle arthrodesis: A systematic approach and review of the literature. World J Orthop 7(11):700CrossRefGoogle Scholar
  37. 37.
    Yoshimura I, Kanazawa K, Takeyama A et al (2012) The effect of screw position and number on the time to union of arthroscopic ankle arthrodesis. Arthroscopy 28:1882–1888CrossRefGoogle Scholar
  38. 38.
    Zwipp H, Rammelt S, Endres T, Heineck J (2010) High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res 468(4):958–968CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • F. B. Imhoff
    • 1
  • S. H. Wirth
    • 1
  • R. S. Camenzind
    • 1
  • A. F. Viehöfer
    • 1
  • C. P. Lampert
    • 2
    Email author
  1. 1.Fuss- und SprunggelenkschirurgieUniversitätsklinik BalgristZürichSchweiz
  2. 2.Orthopädie RosenbergSt. GallenSchweiz

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