The Journal of Bone and Joint Surgery, Vol 74, Issue 6 903-909, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Arthrodesis of the ankle in patients who have rheumatoid arthritis
A Cracchiolo, WR Cimino and G Lian
University of California, School of Medicine, Los Angeles 90024-6902.
We reviewed thirty-two arthrodeses of the ankle in twenty-six patients who
had rheumatoid arthritis. In seventeen patients (eighteen ankles), a
compression arthrodesis was done and external fixation was used. In eight
patients (twelve ankles), we used internal fixation with 6.5-millimeter
cancellous-bone screws. In the remaining patient, an arthrodesis with
external fixation was done in one ankle and internal fixation was used in
the other ankle; data for the appropriate ankle are included in each group.
The patients were followed for an average of thirty-three months. The two
groups were comparable with respect to age, sex, preoperative medications,
and severity of disease. The average time to fusion was nineteen weeks in
the compression arthrodesis group and seventeen weeks in the internal
fixation group. Of the nineteen ankles that had a compression arthrodesis,
four failed to fuse; all of the failures were associated with infection.
Infection developed in two additional patients, there was malposition of
the fusion in three patients, and neurapraxia developed in three patients.
Of the thirteen ankles that had internal fixation, three ankles failed to
fuse; one of the failures was associated with infection. Infection
developed in one additional ankle. In two patients, the ankle fused in
excessive valgus. Comparison of the two groups revealed comparable rates of
fusion: fusion occurred in fifteen of the nineteen ankles in the group that
had compression arthrodesis and in ten of the thirteen ankles in the group
that had internal fixation. The method of arthrodesis did not affect the
time to fusion or the rate of complications.(ABSTRACT TRUNCATED AT 250
WORDS)
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