Minimally Invasive Ankle Arthrodesis



The ankle joint is a constrained mortise and tenon-type joint consisting of the distal tibial plafond and fibula articulating with the dome of the talus. Arthritis of the ankle can result in pain, joint incongruence, decreased motion, and functional disability. The most common etiology of ankle arthritis is posttraumatic, which includes cartilaginous injury and ligamentous insufficiency.1 Other less common causes of arthritis include the inflammatory arthritides, osteonecrosis, infection, and Charcot neuroarthropathy.2

To date, the ankle remains one of the few major extremity joints in which arthrodesis is the gold standard surgical treatment for advanced arthritis that has failed nonoperative management. Open ankle arthrodesis was first described by Albert in 1879.3 Fusion through an open arthrotomy has received numerous modifications since that time, but remains a widely used technique for surgical exposure. Currently, the most common surgical exposure for open ankle arthrodesis is the lateral transfibular approach. Upon osteotomy, the distal fibula can be used either as bone graft or as a lateral strut to increase the stability of the arthrodesis construct. Preparations of the distal tibia and talar dome through these open techniques include either “dome” cuts or flat cuts. Dome cuts allow for minimal loss of height, but do not offer much in terms of angular correction. Straight, flat cuts allow for correction of significant deformity, but can result in loss of joint height.


Distal Tibia Total Ankle Arthroplasty Peroneal Artery Ankle Arthrodesis Distal Fibula 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Raikin S. Arthrodesis of the ankle: arthroscopic, mini-open, and open techniques. Foot Ankle Clin North Am 8: 347–359, 2003CrossRefGoogle Scholar
  2. 2.
    Coughlin M. Arthritides. In: Coughlin M (ed.) Surgery of the foot and ankle. St. Louis: Mosby; pp. 560–650, 1999Google Scholar
  3. 3.
    Albert E. Beitrage zur operativen chiurgie. Zur resection des kniegelenkes. Wien Med Press 20: 705–708, 1879Google Scholar
  4. 4.
    Greisberg J, Assal M, Flueckiger G, Hansen, ST. Takedown of ankle fusion and conversion to total ankle replacement. Clin Orthop Relat Res 424: 80–88, 2004CrossRefPubMedGoogle Scholar
  5. 5.
    Schneider D. Arthroscopic ankle fusion. Arth Video J 3, 1983Google Scholar
  6. 6.
    Morgan C. Arthroscopic tibio-talar arthrodesis. Jefferson Orthop J 16: 50–52, 1987Google Scholar
  7. 7.
    Myerson M, Allon S. Arthroscopic ankle arthrodesis. Contemp Orthop 19: 21–27, 1989Google Scholar
  8. 8.
    Ogilvie-Harris D, Lieberman I, Fitsialos D. Arthroscopically assisted arthrodesis for osteoarthrotic ankles. J Bone Joint Surg 75A: 1167–1173, 1993Google Scholar
  9. 9.
    Zvijac J, Lemak L, Schurhoff M, Hechtman K, Uribe J. Analysis of arthroscopically assisted ankle arthrodesis. Arthroscopy 18(1): 70–75, 2002CrossRefPubMedGoogle Scholar
  10. 10.
    Myerson M, Quill G. Ankle arthrodesis: a comparison of an arthroscopic and an open method of treatment. Clin Orthop Relat Res 268: 84–95, 1991PubMedGoogle Scholar
  11. 11.
    Winson IG, Robinson DE, Allen PE. Arthroscopic ankle arthrodesis. J Bone Joint Surg Br 87(3): 343–347, 2005CrossRefPubMedGoogle Scholar
  12. 12.
    Paremain G, Miller S, Myerson M. Ankle arthrodesis: results after the miniarthrotomy technique. Foot Ankle Int 17(5): 247–252, 1996PubMedGoogle Scholar
  13. 13.
    Demetriades L, Strauss E, Gallina J. Osteoarthritis of the ankle. Clin Orthop Relat Res 349: 48–57, 1998CrossRefGoogle Scholar
  14. 14.
    Raikin SM, Brislin K. Local bone graft harvested from the distal tibia or calcaneus for surgery of the foot and ankle. Foot Ankle Int 26(6): 449–453, 2005PubMedGoogle Scholar
  15. 15.
    Buck P, Morrey BF, Chao EY. The optimum position of arthrodesis of the ankle. A gait study of the knee and ankle. J Bone Joint Surg 69A: 1052–1062, 1987Google Scholar
  16. 16.
    Mann R, Van Manen J, Wapner K, et al. Ankle fusion. Clin Orthop Relat Res 268: 49–55, 1991PubMedGoogle Scholar
  17. 17.
    King H, Watkins T Jr, Samuelson K. Analysis of foot position in ankle arthrodesis and its influence on gait. Foot Ankle 1: 44–49, 1980PubMedGoogle Scholar
  18. 18.
    Wu W, Su F, Cheng Y, et al. Gait analysis after ankle arthrodesis. Gait Posture 11: 54–61, 2000CrossRefPubMedGoogle Scholar
  19. 19.
    Dohm M, Benjamin J, Harrison J, et al. A biomechanical evaluation of three forms of internal fixation used in ankle arthrodesis. Foot Ankle Int 15: 297–300, 1994PubMedGoogle Scholar
  20. 20.
    Ogilvie-Harris D, Fitsialos D, Hedman T. Arthrodesis of the ankle. A comparison of two versus three screw fixation in a crossed configuration. Clin Orthop Relat Res 304: 195–199, 1994PubMedGoogle Scholar
  21. 21.
    Verkelst M, Mulier J, Hoogmartens M, et al. Arthrodesis of the ankle joint with complete removal of the distal part of the fibula: experience with the transfibular approach and three different types of fixation. Clin Orthop Relat Res 118: 93–99, 1976Google Scholar
  22. 22.
    Holt E, Hansen S, Mayo K, et al. Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res 268: 21–28, 1991PubMedGoogle Scholar
  23. 23.
    Nasson S, Shuff C, Palmer D, et al. Biomechanical comparison of ankle arthrodesis techniques: crossed screws vs. blade plate. Foot Ankle Int 22: 575–580, 2001PubMedGoogle Scholar
  24. 24.
    Miller SD, Paremain GP, Myerson MS. The miniarthrotomy technique of ankle arthrodesis: a cadaver study of operative vascular compromise and early clinical results. Orthopedics 1996 19(5): 425–430PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Departments of Orthopaedic SurgeryRothman Institute and Thomas Jefferson University HospitalPhiladelphiaUSA

Personalised recommendations