Majority of patients satisfied with results of ankle arthrodesis

According to investigators, 95% of patients in study would have procedure again.

Issue: November 2004

AOFAS Seattle [icon] Ankle arthrodesis demonstrated long-term durability, according to recent study results, yet the investigators concluded that ankle arthroplasty may hold more promise for the future.

The study, reported by Jonathan R. Faux, MD, of Provo, Utah, at the American Orthopaedic Foot and Ankle Society 20th Annual Summer Meeting, evaluated 23 ankle arthrodeses in 22 patients. Faux’ co-author, Ronald W. Smith, MD, performed the procedures. Most of the operations were done to treat arthritis and fracture.

The study involved nine men and 13 women. Patients’ average age at surgery was 52 years (range 35 to 65 years); at follow-up patients’ average age was 67 years. Follow-up averaged 15 years, with a minimum follow-up of 12 years.

At the time of the patients’ surgeries, Smith used a bimalleolar approach and an external fixation device.

Faux’ study included a detailed on-site clinical, radiographic and validated functional evaluation of patients. Four patients were evaluated by outside examiners. An augmented Modems evaluation tool with SF-36 was used. Results compared with published norms.

Less limping

Unlike previous studies in which patients undergoing ankle arthrodesis often walked with a limp, Faux reported that 94% of patients in his study had no limp or a slight limp. Only one patient in the series had a moderate limp. Faux’ study confirmed the presence of subtalar arthrosis following ankle arthrodesis but at a lower rate than previously reported; also, patients were less symptomatic than previously reported.

Unlike previous studies in which patients undergoing ankle arthrodesis often walked with a limp, investigators reported that 94% of patients in this study had no limp or a slight limp.

Radiographic subtalar arthritis was moderate to severe in 64% of patients, and talonavicular arthritis was found in 18%.

Study results failed to demonstrate the benefit of posterior displacement of the talus during the surgical procedure, according to Faux. “With regard to posterior displacement we found no benefit, and in fact we possibly found a detriment to significant posterior displacement with regard to pain, ankle motion and radiographic arthrosis,” he said.

The study found a statistically significant benefit to mild equinus positioning of the ankle during the procedure, Faux said.

Severe arthrosis, defined as complete narrowing of at least a portion of the joint on exam, was present in the subtalar joint in 35% of patients, and in the talonavicular joint in 9% of patients. There were three late fusions, two subtalar fusions and one triple arthrodesis.

Activities

Uneven ground was painful and difficult for 70% of patients, as was walking fast and running for 90% of patients, Faux reported.

Using the “Get up and go” test and 80 age-matched controls, two patients with ankle arthrodeses did better and 20 did worse than the 50th percentile for age-matched controls. Results of an endurance test consisting of a six-minute walk showed that two patients with ankle arthrodeses did better and 19 did worse than the 50th percentile of age-matched controls.

Patient satisfaction

With regard to patient satisfaction, 91% were definitely satisfied with their ankle fusion, and 75% were neutral, somewhat or very satisfied with keeping their current symptoms for the rest of their lives. Three patients required subsequent surgery, all additional hindfoot arthrodeses. “Ninety-five percent of patients said they would choose the same treatment again,” Faux said.

“Our results alternately demonstrate the long-term durability of ankle fusion in terms of function, symptoms and patient satisfaction and show that there is often poor correlation between radiographic subtalar arthritis and clinical symptoms,” Faux said. “In summary, we certainly hope there will be a greater future for ankle arthroplasty, but ankle fusion still remains the gold standard,” Faux concluded.

Faux and Smith are using the results of the study to develop a clinical guide for both practitioners and patients contemplating ankle fusion.

For more information:

Faux JR, Smith RW. Ankle arthrodesis: Long-term functional and clinical performance. Presented at the American Orthopaedic Foot and Ankle Society 20th Annual Summer Meeting. July 29-31, 2004. Seattle.