Long-term follow-up after arthrodesis of the ankle and the hindfoot

Abstract

The present study relates subjective and objective follow-up results more than 10 years following arthrodesis of the ankle and the hindfoot. One hundred and fifty-five arthrodeses (ankle joint, triple arthrodeses, subtalar, pantalar and talonavicular arthrodeses) were performed on 147 patients between 1968 and 1988. The most common indication was post-traumatic arthritis, followed by congenital deformity, idiopathic degenerative arthritis and rheumatoid arthritis. A variety of internal fixation devices were used in some cases; seventy-nine patients with 82 arthrodeses were reexamined clinically and radiographically, after a mean time of 11.1 years. Static and dynamic foot print measurements were recorded with a capacitive sensor system. Another 26 patients with 27 arthrodeses replied to a questionnaire. Subjectively, the average pain score improved significantly but the overall function score improved only slightly. Results were inferior in the talonavicular arthrodesis. Radiographical evaluation revealed bony union in only 59% of the arthrodeses, one-third at the talonavicular joint. Secondary degenerative arthritis of the foot and ankle occurred in 107 joints of the 82 feet re-examined. Evaluation of dynamic foot pressure measurements revealed an overall prolonged weightbearing on the midfoot region. An unacceptably low rate of bony union in some locations, a high incidence of secondary degenerative changes at neighbouring joints and a persistent abnormality of the plantar weightbearing pattern in the operated feet demonstrate unsatisfactory results with the techniques used more than 10 years ago. We now recommend stable internal fixation with optimum adaptation of the bone surfaces of the arthrodesis.