Hindfoot preservation may yield similar outcomes to hindfoot fusion for ankle arthritis
Click Here to Manage Email Alerts
Key takeaways:
- Hindfoot fusion for ankle arthritis resulted in similar outcome scores as hindfoot preservation.
- Implant survivorship was insignificantly different between the hindfoot group and preservation group.
Preservation of the hindfoot joints in patients undergoing total ankle arthroplasty for ankle arthritis and adjacent hindfoot arthritis may yield similar outcomes as hindfoot fusion, according to results.
“In our data, we suggest that the presence of radiographic arthritis in the talonavicular joint or the subtalar joint does not always mean that you have to fuse the joints,” Mohammad A. Arafah, MBBS, musculoskeletal oncology and foot and ankle reconstruction fellow at the University of Toronto, said in his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting. “Deferral of hindfoot fusion, based of course on the clinical judgement of the surgeon and the patient’s demographics and data, is a reasonable option in [Canadian Orthopaedic Foot and Ankle Society] COFAS type 4 ankle arthroplasties.”
Using the COFAS database, Arafah and colleagues retrospectively reviewed data from 148 ankles with COFAS type 4 arthritis that underwent total ankle arthroplasty. Researchers compared preoperative and 1, 2 and 3-to-5-year postoperative Ankle Osteoarthritis Scale (AOS) and SF-36 physical component summary scores between 89 ankles that received fusion of the adjacent subtalar or talonavicular joint and 59 ankles that received preservation of the hindfoot.
Although both groups had significant improvements when comparing preoperative and last follow-up AOS scores, Arafah said AOS scores and SF-36 scores had an insignificant difference at last follow-up when comparing the fusion group and preservation group.
“When we compared both AOS scores over 5 years duration, we noted that the best score the cohort achieved was at the 2-year mark postoperatively,” Arafah said. “When performing multivariate analysis controlling for demographics, comorbidities, different surgeons, different implants and preoperative AOS scores, it was insignificantly different at last follow-up between both groups.”
Arafah said two patients in the preservation group required reoperation for hindfoot fusions and two patients required revision due to loosening. Although no patients in the fusion group required revision of the implant, Arafah said five patients had wound complications that required surgical intervention and four patients required hardware removal.
“The survivorship of the implants in both groups were insignificantly different,” Arafah said.
Collapse
Arafah MA, et al. Adjacent joint preservation vs. fusion in patients with ipsilateral hindfoot and ankle arthritis (COFAS type 4) undergoing total ankle arthroplasty: A comparison of prospectively collected outcomes. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 11-14, 2024; Vancouver, British Columbia, Canada (hybrid meeting).
Read more about
Click Here to Manage Email Alerts