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Ankle Distraction Arthroplasty With External Fixation
Ankle distraction arthroplasty is one method of ankle joint preservation in patients with arthritis. Joint preservation generally includes correction of bony and soft-tissue deformities, ankle joint débridement, and soft-tissue balancing. Distraction arthroplasty is based on the hypothesis that articular cartilage repair can occur when the joint is unloaded and subjected to intermittent fluid pressure changes, which has been shown in animal and in vitro studies to alter the cartilage matrix turnover. In addition, subchondral bone remodeling, which has been linked to clinical improvement, can occur with distraction and may affect cartilage repair. Joint unloading is maintained for several months with a ring external fixator device. During this period, loading and unloading of the joint with weight bearing results in intra-articular hydrostatic pressure changes. This chapter reviews the surgical technique and surrounding knowledge for ankle distraction arthroplasty using a ring external fixation device.