Mads Sundet1, Elena Johnsen2, Kari Helene Eikvar3, Marianne Lund Eriksen4. 1. Consultant Foot and Ankle Surgeon, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: mads.sundet@icloud.com. 2. Consultant Radiologist, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: elenajohnsen@gmail.com. 3. Department of Professional Affairs,The Norwegian Medical Association, Oslo, Norway. Electronic address: Kari.Eikvar@legeforeningen.no. 4. Consultant Foot and Ankle Surgeon, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: Marianne.Eriksen@diakonsyk.no.
Abstract
BACKGROUND: Ankle fusion after removal of alloplasty is known to be a procedure with a high potential for non-unions and poor function, especially tibio-talo-calcaneal fusion. We wanted to review our results after using a novel method for the procedure, combining retrograde nailing with a trabecular metal implant and bone marrow aspirate concentration applied in an ostoconductive pad in addition to autologous bone grafting. MATERIALS AND METHODS: Retrospective review of a patient series, with some prospectively registered data. 31 ankles in 30 patients were operated from January 2016 to February 2019. RESULTS: There were two non-unions (6.5%), and one delayed union, none of these were reoperated. The mean postoperative Manchester-Oxford Foot and Ankle Questionnaire score (MOxFQ) was 33.6 points. 9 patients scored an average MOxFQ at 72.9 immediately before surgery, while at follow-up this had decreased to 36.2, an improvement of 36.7 points (95% CI 18.3-54.9). There were 1 minor infection and 5 possible nerve injuries. One patient had the leg amputated 1 year after the surgery due to a non-related necrotizing fasciitis. CONCLUSION: We present reasonably good short to medium term patient satisfaction and fusion rates with this novel combination of techniques.
BACKGROUND: Ankle fusion after removal of alloplasty is known to be a procedure with a high potential for non-unions and poor function, especially tibio-talo-calcaneal fusion. We wanted to review our results after using a novel method for the procedure, combining retrograde nailing with a trabecular metal implant and bone marrow aspirate concentration applied in an ostoconductive pad in addition to autologous bone grafting. MATERIALS AND METHODS: Retrospective review of a patient series, with some prospectively registered data. 31 ankles in 30 patients were operated from January 2016 to February 2019. RESULTS: There were two non-unions (6.5%), and one delayed union, none of these were reoperated. The mean postoperative Manchester-Oxford Foot and Ankle Questionnaire score (MOxFQ) was 33.6 points. 9 patients scored an average MOxFQ at 72.9 immediately before surgery, while at follow-up this had decreased to 36.2, an improvement of 36.7 points (95% CI 18.3-54.9). There were 1 minor infection and 5 possible nerve injuries. One patient had the leg amputated 1 year after the surgery due to a non-related necrotizing fasciitis. CONCLUSION: We present reasonably good short to medium term patient satisfaction and fusion rates with this novel combination of techniques.