Clinical Analysis on the Treatment of Kaschin-Beck Disease of the End-Stage Ankle by Tibiotalocalcaneal Arthrodesis Using Lateral Approach With Platelet-Rich Plasma

CATEGORY: Ankle Arthritis; Ankle INTRODUCTION/PURPOSE: Objective To study the effectiveness of treated Kaschin-Beck Disease of the ankle by tibiotalocalcaneal arthrodesis using lateral approach with autologous platelet-rich plasma. METHODS: Retrospective analysis was conducted on the clinical effect of our department on the treatment of 23 patients (25 ankle joints) with severe Kaschin-Beck Disease from May 2014 to May 2016. All patients were treated with tibiotalocalcaneal arthrodesis by using lateral approach of fibula osteotomy with distal fibula cancellous bone combined with autologous platelet rich plasma for bone grafting and internal fixation with full thread cannulated screws or auxiliary lateral plate. Surgical time, blood loss, joint fusion time, delayed wound healing, infection, nonunion of osteotomy surface, chronic pain and other complications were recorded. VAS score and AOFAS ankle and hind foot score were compared before and at the last follow-up. RESULTS: The mean healing time was 14.7 weeks. Postoperative wound healing was delayed in 3 patients. One patient developed superficial infection 1 week after surgery. Bone graft absorption, nonunion of osteotomy surface and loosening of internal fixation were observed in 2 patients. The bone healed at 13 weeks after surgery. 22patients were followed up for an average of 15.7 months. The postoperative AOFAS score was 76 points, and the postoperative VAS score was 2 points with statistically significant differences from the preoperative AOFAS (t=19.13, P<0.01) and VAS (t=17.27, P<0.01). In 21 cases, tibial calcaneal joint fusion was performed in the first stage, and the fusion rate was 87.5%.21 patients received the first stage of bone fusion after surgery, and the fusion rate was 87.5%. CONCLUSION: Ankle joint and subtalar joint can be well exposed through the lateral approach of fibular osteotomy. The distal fibula autograft with sufficient cancellous bone mass and the combination of autologous platelet rich plasma graft can promote bone healing, and the reliable internal fixation can help achieve satisfactory clinical effect of tibiotalocalcaneal arthrodesis.