Total Ankle Replacement and Simultaneous Subtalar Arthrodesis

Abstract

Category: Ankle Arthritis Introduction/Purpose: Patients with arthritis or severe malfunctions involving both the ankle and the subtalar joints can benefit tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. Actually, TTC fusion is considered as a salvage option resulting in a completely stiff ankle and hindfoot, considerably limiting global foot function. With the evolution of prosthetic design and surgical techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. Methods: This study includes 25 patients who underwent primary TAR and simultaneous subtalar fusion from May 2011 to November 2014. Sixteen males (64%) and 9 females (36%) were enroled with a mean age of 58 years (25-82). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Radiographic examination included a postoperative CT scan obtained 12 months after surgery. Results: At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92%. There was a statistically significant increase in American Orthopedic Foot & Ankle Society ankle/hindfoot score from 27.9 to 75.1. Range of motion significantly increased from 12 to 32.8 degrees. In addition, there was a statistically significant decrease in visual analog scale (VAS) pain score from 8.6 to 2.1. Conclusion: TAR and simultaneous subtalar joint fusion are reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopaedic surgeons in determining the degree of successful fusion of subtalar arthrodesis.