Outcomes After Total Ankle Replacement in Association With Ipsilateral Hindfoot Arthrodesis.
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
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https://hdl.handle.net/10161/8902Published Version (Please cite this version)
10.1177/1071100714528495Publication 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Samuel Bruce Adams Jr.
Associate Professor of Orthopaedic Surgery
James Keith DeOrio
Professor of Orthopaedic Surgery
Mark Erik Easley
Associate Professor of Orthopaedic Surgery
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
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