Ankle Arthrodesis Using the Ilizarov Technique in Difficult Situations - a Prospective Study with Mid-to Long-term Follow up.

BACKGROUND Although various operative techniques are available for ankle arthrodesis, it is not rare to see orthopaedic surgeons facing difficult situations with ankles that cannot be reliably treated by any conventional methods other than the Ilizarov technique. This study was conducted to measure the outcome in such patients using the Ilizarov Ring fixator. MATERIAL AND METHODS Sixteen patients (average age 47.5 years) had primary or revision unilateral ankle arthrodesis using the Ilizarov technique. Among the 16 patients the pathology included severe difficult posttraumatic arthritis with diabetes mellitus (n=7), failed arthrodesis with internal fixation (n=4), difficult post-septic arthritis (n=3) and 1 case each of rheumatoid arthritis and post-polio residual palsy with instability. The primary outcome was bony union and ankle alignment. The clinical results were further evaluated according to the American Orthopaedic Foot and Ankle Society scoring (AOFAS) System at 6 months and yearly till final follow-up. RESULTS All ankles achieved arthrodesis at an average of 14 weeks (range 12-18 weeks). The average duration of follow-up was 5.7 years (range 4- 10 years). No major complication was seen except for 5 cases of superficial pin track infections, wound dehiscence in 1 patient and chronic discharging sinus in 1 patient. The average AOFAS score improved from an average of 35.25 (range 20- 44) points pre-operatively to an average of 78.37 (range 72-89) points at final follow-up. CONCLUSION Ankle arthrodesis using Ilizarov technique shows a high fusion rate with no major complications and operative failures even in difficult and complicated situations.