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Significant improvements found after total ankle arthroplasty with ipsilateral hindfoot arthrodesis
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Although patients who underwent ipsilateral hindfoot arthrodesis and total ankle arthroplasty showed significant improvements in function and pain relief at mid-term follow-up, researchers noted the overall results were slightly worse than patients who had isolated total ankle arthroplasty.
“We caution that overall outcome and failure rate may be inferior to that of isolated total ankle replacement at least at mid-term follow-up,” John S. Lewis Jr., MD, said.
Lewis and colleagues prospectively studied 396 patients (404 ankles) with an average follow-up of 3.2 years. The researchers compared the failure rates and outcomes of 334 isolated total ankle arthroplasties (TAAs) to 70 patients who had an ipsilateral hindfoot arthrodesis performed before, during or after TAA. The researchers included patients who underwent hindfoot fusions in their study, but excluded patients who had midfoot or forefoot fusions, take-downs of tibiotalar fusions to primary TAAs or any revision procedures.
Failure rates
The researchers identified a 10% failure rate in the arthrodesis group, which was significantly higher than the TAA group. The failure rate for the isolated TAA group was 2.4%.
Total ankle replacement is shown in the
setting of a subtalar arthrodesis.
Image: Lewis JS
“Failure was defined as revision requiring a change of one or more of the metal components, or a need for ankle or tibiotalocalcaneal fusion,” Lewis said.
At follow-up, both groups showed significant improvements from preoperative values for Foot and Ankle Disability Index, Short Musculoskeletal Function Assessment and SF-36 scores.
FDA-approved implants
Patients who underwent arthrodesis and TAA showed significant improvements in Visual Analog Scale pain scores and total American Orthopaedic Foot and Ankle Society scores compared to their preoperative scores, but the isolated TAA group showed better scores than patients who underwent arthrodesis. Both groups showed improvements in walking speed, sit-to-stand time and four-square step time, but the isolated TAA group showed faster times for all measurements compared to the arthrodesis group at most recent follow-up.
“This is, to our knowledge, the first series utilizing implants available in the United States looking at the outcome of total ankle replacement in concert with an ipsilateral hindfoot arthrodesis,” Lewis said, referencing similar studies done in Europe, but with implants not available in this country. “We have shown that you can expect significant improvements in pain and function.” — by Renee Blisard Buddle
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Disclosure: Lewis has no relevant financial disclosures.