Ankle Arthrodesis 27870

synonyms:tibiotalar arthrodesis, tibiotalar fusion, ankle fusion

Ankle Arthrodesis CPT

• 27870 Arthrodesis, ankle, open
• 29899 Arthroscopy, ankle; with ankle arthrodesis 

Ankle Arthrodesis Indications

Ankle Arthrodesis Contraindications

• Talar AVN (consider Blair technique)
• Peripheral neuropathy (relative; high nonunion rate; consider AFO/bracing)
• Severe osteoporosis
• Infection (consider fusion with external fixation)

Alternatives

• Conservative care  (NSAIDs, soft-laced ankle gauntlet, AFO)
• Arthroscopic ankle arthrodesis
• Ankle arthrodesis in situ

Ankle Arthrodesis Pre-op Planning

• see (Gougoulias NE, Foot Ankle Int 2007;28:695) for arthroscopic technique
• -Patient Guides: eOrthopod,
• For fusion after TAA failure see: (Cuplan P, JBJS 2007;89Br:1178)
• Can use proximal humeral locking plate (Ahmad J, Foot Ankle Int 2007;28:977)
• Ankle arthrodesis plates are available from Tournier and .....
• Screw techniques: Acumed
• Consider having external fixator available as an alternative if screw fixation is not rigi

Ankle Arthrodesis Technique

• Sign operative site.
• Pre-operative antibiotics, +/- regional block.
• General endotracheal anesthesia
• position. All bony prominences well padded.
• Examination under anesthesia.
• Prep and drape in standard sterile fashion.
• Irrigate.
• Close in layers.

Ankle Arthrodesis Complications

Ankle Arthrodesis Follow-up care

• Post-op:
• 7-10 Days:
• 6 Weeks:
• 3 Months:
• 6 Months:
• 1Yr:

Ankle Arthrodesis Outcomes

• >90% fusion rate with arthroscopic ankle arthrodesis (Gougoulias NE, Foot Ankle Int 2007;28:695)
• (Coester LM, JBJS 83A:219;2001)

Ankle Arthrodesis Review References

• Coester LM, JBJS 83A:219;2001
• Zwipp H, Rammelt S, Endres T, Heineck J. High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res. 2010 Apr;468(4):958
• Abidi NA, JAAOS 2000;8:200
• Easley ME, Montijo HE, Wilson JB, Fitch RD, Nunley JA 2nd. Revision tibiotalar arthrodesis. JBJS Am. 2008 Jun;90(6):1212-23.
• Plaass C, Knupp M, Barg A, Hintermann B. Anterior double plating for rigid fixation of isolated tibiotalar arthrodesis. Foot Ankle Int. 2009 Jul;30(7):631-9.
• Levine SE, Myerson MS, Lucas P, Schon LC. Salvage of pseudoarthrosis after tibiotalar arthrodesis. Foot Ankle Int. 1997 Sep;18(9):580-5.
• Colman AB, Pomeroy GC. Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome. Foot Ankle Int. 2007 Mar;28(3):303-7.
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