Wound Issues/Fusion Rate Trade-off Subject of Foot Study

When orthopedic surgeons perform ankle arthrodesis, one trade-off can be elevated risk of post operative wound problems. A new study examines that issue and concludes that anterior fusion plating in conjunction with tibialis anterior tenotomy, bottom line, improves outcomes for patients with end-stage ankle arthritis.

The study, “The Effects of Tibialis Anterior Tenotomy on Wound Complications and Functional Outcomes after Anterior Fusion Plating for Severe Ankle Arthritis,” was published online on July 5, 2022 in the Journal of Foot & Ankle Surgery.

“Nonunion is known to be a relatively common complication following ankle arthrodesis. Various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate,” the researchers wrote.

The research team enrolled 84 patients, 46 of whom were treated with ankle arthrodesis using anterior fusion plate and then were followed for more than 2 years. Tibialis anterior tenotomy was performed prior to wound closure in all patients. The remaining 38 patients comprised the control arm of the study and they were treated with arthrodesis but without tibialis anterior tenotomy.

The team collected outcome data from all study participants using the Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure as well as, specifically, wound complication rate, time to fusion, fusion rate, time to pain relief.

Overall, the research team found that mean Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure scores were significantly improved to 32.6 and 69.4 points at final follow-up.

While there were no significant differences in functional outcomes compared with the control, the tibialis anterior tenotomy group had significantly lower wound complication rate than the control group (4.3% vs. 23.7%; p < 0.001). The control group also had a higher rate of implant removal.

“Ankle arthrodesis using anterior fusion plate in conjunction with tibialis anterior tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with excellent fusion rate and less wound complication rate,” the researchers wrote.

“Although there were no specific functional deficits related to absence of tibialis anterior tendon, further studies are needed to determine long-term effects of tibialis anterior tenotomy in patients with a fused ankle.”

Study authors include Seok-Won Kim, M.D., Seung-Myung Choi, M.D., Min-Boo Kim, M.D., and Byung-Ki Cho, M.D., of the Chungbuk National University Hospital in Cheongiu, Korea. Seung-Myung Choi, M.D., of the Eulji University School of Medicine, Uijeonaby Hospital, Korea, also contributed to the study.