Percutaneous Arthrodesis in the Rheumatoid Ankle

Abstract

Summary 

It has been generally accepted that residual cartilage and subchondral bone has to be removed to get bony fusion in arthrodeses. In 1998, we reported successful fusion of 11 rheumatoid ankles, all treated with percutaneous fixation only. This method is restricted for ankles with normal or at least functional alignment. Animal studies confirmed that it is possible to achieve arthrodesis without removal of cartilage and that synovial depletion is the possible mechanism behind cartilage disappearance. The stability of the fixation achieved at arthrodesis surgery is an important factor in determining success or failure. A good fit of the bone surfaces appears necessary. The results of our biomechanical studies indicate that the arch shape and the subchondral bone should be preserved performing ankle arthrodesis. The importance of this is likely to increase in weak rheumatoid bone. Overall, inserting the 2 screws at a 30° angle with respect to the long axis of the tibia and crossing them above the fusion site improves stability for ankle arthrodesis. In conclusion, the percutaneous technique is suitable for patients with rheumatoid arthritis and a painful ankle with complete loss of joint space but with no deformity to correct.