Transfibular ankle arthrodesis for ankle arthritis with more than 15 degree of coronal plane deformity: analysis of 28 feet treated by arthrodesis with autologous fibular graft

Introduction: This study reviewed the outcome of 28 patients with ankle arthritis treated by ankle arthrodesis with autologous bone grafts using a transfibular approach in ankles with end-stage ankle arthritis with 15° or more deformity of the coronal plane.

Methods and Materials: Between January 2012 and September 2018, 28 ankle arthrodesis with fibular grafts using transfibular approaches were performed in patients with ankle arthritis with deformities. Varus and valgus deformity of the coronal plane was measured from standing ankle anterior-posterior radiographs and hindfoot alignment angle and hindfoot alignment ratio were measured on hindfoot alignment radiographs. The clinical outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scores and Visual Analog Scale (VAS) pain scores. Paired t-tests were used to analyze the preoperative and postoperative HAA, HAR, AOFAS scores, and VAS scores.

Results: The mean time to bone union was 10.7 weeks. Twenty-six of 28 patients (92.8%) had a bony fusion within six months. In the radiographic parameters, the mean hindfoot alignment ratio ranged from 0.51° ± 0.39° preoperatively to 0.28° ± 0.13° postoperatively and the mean hindfoot alignment angle was improved from -10.56° ± 13.54° preoperatively to 2.25° ± 3.79° postoperatively. With regard to clinical outcomes, the AOFAS scores and VAS pain scores had improved at follow-up. The radiographic and clinical outcomes were significantly improved (p<0.05).

Conclusion: Transfibular ankle arthrodesis with an autologous fibular graft can be an excellent treatment option for ankles with more than 15 degrees of coronal plane deformity.