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

Lewis, John S

Adams, Samuel B

Queen, Robin M

DeOrio, James K

Nunley, James A

Easley, Mark E

United States

2014-06-20T02:03:22Z

2014-06

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.

http://www.ncbi.nlm.nih.gov/pubmed/24677216

1071100714528495

1944-7876

https://hdl.handle.net/10161/8902

eng

SAGE Publications

Foot Ankle Int

10.1177/1071100714528495

arthritis

hindfoot arthrodesis

total ankle replacement

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

Journal article

Adams, Samuel B|0000-0003-1020-1167

DeOrio, James K|0000-0001-5181-9049|0000-0003-1231-8203

Nunley, James A|0000-0002-3825-7536

Easley, Mark E|0000-0003-2995-3908

http://www.ncbi.nlm.nih.gov/pubmed/24677216

535

542

6

Clinical Science Departments

Duke

Faculty

Orthopaedics

School of Medicine

Published

35