Salvage of failed ankle arthrodesis after posttraumatic septic arthritis by Ilizarov external fixator: mid-term results

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Background:Failed septic ankle arthrodesis is a challenging problem. This study evaluated the results of salvage revision ankle arthrodesis using Ilizarov external fixation to treat nonunited arthrodesis of posttraumatic septic ankle arthritis and to analyze the functional outcome of this method.Methods:This prospective study included 14 patients with a mean age of 48 yr. Patients had already undergone a mean of 4.43 previous surgeries at a mean of 17.14 mo from primary arthrodesis. Five patients had associated deformity. The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 23.93. Meticulous debridement was done and an Ilizarov fixator was applied in compression in a one-stage procedure.Results:The mean follow up period was 41.71 mo with mean external fixation period of 17.29 wk. Successful arthrodesis in perfect alignment was achieved in 13 of 14 patients without additional procedures. One ankle did not go on to union. A chronic discharging sinus persisted in one patient. One infected loose wire was exchanged in two patients. One diabetic patient reported moderate daily diffuse pain. The mean postoperative AOFAS ankle-hindfoot score was 71.57. Patients with successful fusion were satisfied with the procedure.Conclusions:Using an Ilizarov fixator to salvage nonunited septic posttraumatic ankle arthrodesis was effective, with patients reporting a stable ankle and dramatic functional improvement with minimal complications.

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