Medium- to Long-Term Outcome of Ankle Arthrodesis

Abstract

Background: Despite improvement in outcome after ankle arthroplasty, fusion of the ankle joint is still considered the gold standard. A matter of concern is deterioration of clinical outcome as a result of loss of motion and advancing degeneration of adjacent joints. We performed a long-term study to address these topics. Methods: Between 1990 and 2005 a total of 121 ankle arthrodeses were performed at our institute. Thirty-five cases were excluded because of simultaneous subtalar arthrodesis. Ten had died and ten were lost to followup. Six had a bilateral ankle arthrodeses, leaving 60 patients (66 ankles) eligible for followup. There were 40 males and 26 females with a mean age at surgery of 47 years. In 60 ankles, fusion was obtained using a two-incision, three-screw technique. All patients were assessed using validated questionnaires and clinical rating systems: Short Form 36 (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot scale, Foot and Ankle Ability Measure (FAAM) and a subjective satisfaction rating. Radiological progression of osteoarthritis of the adjacent joints was assessed. Results: Fusion was achieved in 91% after primary surgery. In six patients rearthrodesis was needed to obtain fusion. The mean SF-36 score was 63 (SD, 22) for the physical component scale and 81 (SD, 15) for the mental component scale. The mean FAAM score was 69 (SD, 17) and the mean AOFAS Ankle Hindfoot score was 67 (SD, 12). Ninety-one percent were satisfied with their clinical result. Infection occurred once. No other serious adverse events were encountered. In all contiguous joints significant progression of arthritis was appreciated. Conclusion: Ankle arthrodesis using a two-incision, three-screw technique was a reliable and safe technique for the treatment of end-stage osteoarthritis of the ankle. It resulted in a good functional outcome at a mean followup of 9 years. Progressive osteoarthritis of the contiguous joints was clearly appreciated but the functional and clinical importance of these findings remains unclear. Level of Evidence

Are our expectations bigger than the results we achieve? A comparative study analysing potential advantages of ankle arthroplasty over arthrodesis

“…Deterioration of the arthritic changes in the subtalar joint was already previously reported in 15 % of patients five years after TAR [23]. At a mean follow up of nine years after arthrodesis, progressive osteoarthritis of the contiguous joints was also appreciated in other studies, however rarely becoming symptomatic in these patients [24]. It has not yet been shown that long-term results after ankle replacement are superior with regard to adjacent joint Values are given as mean ±SD.…”

Patient satisfaction and function after bilateral ankle arthrodeses

“…In the first 2 years following bilateral TAR, the functional outcome is inferior to that of unilateral TAR. After this point, the difference disappears with mean AOFAS scores at 2 years of 72 (range 54-90) and 75.9 (range 50-96) respectively [5]. Bilateral TAR offers good functional outcome, substantial pain relief [11] and improves all aspects of the SF-36 [14].…”

“…Both AA and TAR have been shown to significantly improve overall function [4] and the benefit of unilateral AA in particular can be seen to persist into the medium [5] and up to 20 years post-operatively [6]. However, whilst there is a perceived benefit for TAR [7,8] particularly in those with bilateral ankle OA [7], the evidence supporting the use of TAR over AA is weak and the optimum way to manage those with bilateral ankle OA remains unclear.…”

Ankle Arthrodesis With Three Cancellous Screws

“…), ин-трамедуллярных гвоздей, винтов и пластин, а также вариантами применения костной пластики [12][13][14][15][16]. при этом наиболее частыми причинами неудач яв-ляются несращения и инфекционные осложнения [17][18][19].…”