Inflammatory hindfoot arthrodesis outcomes compared

By Lynda Williams, Senior medwireNews Reporter

Choice of arthrodesis for patients with rheumatoid arthritis or spondyloarthritis hindfoot disease should be guided by the extent of damage present, research indicates.

The review of 84 feet operated on between 1996 and 2009 suggests that double arthrodesis provides the best restoration for patients with maligned hindfoot with diffuse arthritis, say Marie Munoz (Lapeyronie University Hospital, Montpellier, France) and co-workers.

However, the team recommends that patients with isolated disease and a reducible malalignment should undergo talocalcaneal or talonavicular arthrodesis due to a trend toward a lower rate of revision surgery for these procedures compared with double arthrodesis.

Over an average of 7 years of follow up, 22% of double arthrodesis in 39 feet required revision compared with just 11% of 54 talonavicular arthrodeses, and 14% of the 14 talocalcaneal arthrodeses.

There was also a trend toward a shorter time to revision with double than talonavicular arthrodesis (4.0 vs 1.6 years). The researchers suggest this indicates a "pathological" deterioration in the ankle after double arthrodesis, adding that time to revision surgery "seemed very short in view of the mean hindfoot diagnosis-to-surgery interval of 15 years."

Nevertheless, 62% of patients were pain-free at follow up and there was no significant difference in satisfaction between double, talonavicular, and talocalcaneal arthrodesis patients (92, 84, and 100%, respectively).

Patients achieved a mean postoperative American Orthopaedic Foot And Ankle Society score of 71.7 out of 100, indicating little or no limitation of everyday activities, and there was no significant difference between the surgery groups.

Patients who underwent double arthrodesis had a significantly greater Djian-Annonie angle than the other patients before surgery, but there was no postoperative difference, indicting significantly greater improvement with double arthrodesis.

Of the 24 complications reported in 20 patients, nonunion occurred in 50% of cases, and was significantly more common in talonavicular than double arthrodesis (21% of 42 versus 10% of 31 cases). There were no cases of nonunion in the patients who underwent talocalcaneal arthrodesis.

"These findings support Suckel's cadaver studies, which, in 2007, reported early deterioration in ankle status in double arthrodesis, due to mechanical overloading," Munoz et al conclude in Orthopaedics and Traumatology: Surgery and Research.

"Talocalcaneal arthrodesis proved reliable and simple, free of major complications and with a 100% satisfaction rate."

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