Arthrodesis of the ankle joint with rheumatoid arthritis: experience with the transfibular approach.

There are man methods of ankle joint arthrodesis, but nearly all are used for treatment of posttraumatic talocrural joint arthritis. Relatively few case reports of ankle arthrodesis are found in the literature on rheumatoid arthritis. The transfibular approach is remarkably effective for the fusion of talocrural joints destroyed and deformed by rheumatoid arthritis. In nine cases, the overall results were excellent in six and good in three. A sliding inlay graft in one case also produced a good result. Because patients with rheumatoid arthritis have osteoporosis caused by steroid therapy or its disuse, and some vascular disease, compression arthrodesis is unsafe. Moreover, the lateral transfibular approach provides better surgical exposure as well as protecting fragile rheumatoid tendons, vessels and nerves.