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Outcomes After Total Ankle Replacement in Association With Ipsilateral Hindfoot Arthrodesis.

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Date
2014-06
Authors
Lewis, John S
Adams, Samuel B
Queen, Robin M
DeOrio, James K
Nunley, James A
Easley, Mark E
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Abstract
BACKGROUND: Ipsilateral hindfoot arthrodesis in combination with total ankle replacement (TAR) may diminish functional outcome and prosthesis survivorship compared to isolated TAR. We compared the outcome of isolated TAR to outcomes of TAR with ipsilateral hindfoot arthrodesis. METHODS: In a consecutive series of 404 primary TARs in 396 patients, 70 patients (17.3%) had a hindfoot fusion before, after, or at the time of TAR; the majority had either an isolated subtalar arthrodesis (n = 43, 62%) or triple arthrodesis (n = 15, 21%). The remaining 334 isolated TARs served as the control group. Mean patient follow-up was 3.2 years (range, 24-72 months). RESULTS: The SF-36 total, AOFAS Hindfoot-Ankle pain subscale, Foot and Ankle Disability Index, and Short Musculoskeletal Function Assessment scores were significantly improved from preoperative measures, with no significant differences between the hindfoot arthrodesis and control groups. The AOFAS Hindfoot-Ankle total, function, and alignment scores were significantly improved for both groups, albeit the control group demonstrated significantly higher scores in all 3 scales. Furthermore, the control group demonstrated a significantly greater improvement in VAS pain score compared to the hindfoot arthrodesis group. Walking speed, sit-to-stand time, and 4-square step test time were significantly improved for both groups at each postoperative time point; however, the hindfoot arthrodesis group completed these tests significantly slower than the control group. There was no significant difference in terms of talar component subsidence between the fusion (2.6 mm) and control groups (2.0 mm). The failure rate in the hindfoot fusion group (10.0%) was significantly higher than that in the control group (2.4%; p < 0.05). CONCLUSION: To our knowledge, this study represents the first series evaluating the clinical outcome of TARs performed with and without hindfoot fusion using implants available in the United States. At follow-up of 3.2 years, TAR performed with ipsilateral hindfoot arthrodesis resulted in significant improvements in pain and functional outcome; in contrast to prior studies, however, overall outcome was inferior to that of isolated TAR. LEVEL OF EVIDENCE: Level II, prospective comparative series.
Type
Journal article
Subject
arthritis
hindfoot arthrodesis
total ankle replacement
Permalink
https://hdl.handle.net/10161/8902
Published Version (Please cite this version)
10.1177/1071100714528495
Publication Info
Lewis, John S; Adams, Samuel B; Queen, Robin M; DeOrio, James K; Nunley, James A; & Easley, Mark E (2014). Outcomes After Total Ankle Replacement in Association With Ipsilateral Hindfoot Arthrodesis. Foot Ankle Int, 35(6). pp. 535-542. 10.1177/1071100714528495. Retrieved from https://hdl.handle.net/10161/8902.
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Scholars@Duke

Adams

Samuel Bruce Adams Jr.

Associate Professor of Orthopaedic Surgery
DeOrio

James Keith DeOrio

Professor of Orthopaedic Surgery
Easley

Mark Erik Easley

Associate Professor of Orthopaedic Surgery
Nunley

James Albert Nunley II

Goldner Jones Distinguished Professor of Orthopaedic Surgery
My current research interests are both clinical and basic science. Currently, in the Orthopaedic Research Laboratory, we are investigating the biomechanical properties of the deltoid ligament in the ankle. This is a clinically relevant problem and we will hopefully identify ways to improve the correction of the adult relaxed flat foot. We are also performing a preliminary investigation into the blood supply of the distal tibia to look for a vascularized bone transfer. We have

Robin Marie Queen

Assistant Professor of Orthopaedic Surgery
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
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