Ankle arthrodesis and its relationship to ipsilateral arthritis of the hind- and mid-foot

Abstract

It has been suggested that arthrodesis of the ankle leads to osteoarthritis of the joints of the ipsilateral hind- and midfoot. We believe these studies overlooked the presence of osteoarthritic changes in these joints before the arthrodesis. We reviewed the pre-operative radiographs of 70 patients with osteoarthritis of the ankle who underwent 71 ankle arthrodeses (one was bilateral). The talonavicular, calcaneocuboid, subtalar and naviculocuneiform joints were given an osteoarthritis score according to Kellgren and Lawrence. The mean age at operation was 54.9 years and the most common indication was for post-traumatic osteoarthritis (52 cases). A total of 68 patients showed pre-existing arthritis in either the hind- or mid-foot, with the subtalar joint the most commonly affected. Ipsilateral hind- and mid-foot arthritis is almost universally present in patients with arthritis of the ankle requiring arthrodesis. The presence of such changes may not be a consequence of this arthrodesis.

High Union Rates and Function Scores at Midterm Followup With Ankle Arthrodesis Using a Four Screw Technique

“…During the followup period, we observed development of arthritis at the subtalar joint in 16.6% and at the talonavicular joint in 11.1% of patients and progression of preexisting arthritis 30% and 19%, respectively. Our observations confirm those of Sheridan et al [43] who reported a high percentage (96%) of subtalar and midfoot arthritis was preexisting due to ankle malfunction in end-stage arthritis. Progression of preexisting arthritis has been reported in between 0 and 70% [5,27,30,48].…”

“…Long-term studies with followup of more than 20 years revealed a high percentage (ie, 47% to 100%) of arthritis at the adjacent joints [11,17,51]. However, only few studies reported the amount of preexisting arthritis of these joints [5,27,43,48] and the clinical relevance of radiographic signs of arthritis is not entirely clear [4,37,51].…”

Patient satisfaction and function after bilateral ankle arthrodeses

“…It also highlights that following AA there is an increased mobility in the ipsilateral transverse tarsal and subtalar joints which plays an important role in compensating for a stiff ankle. This compensatory movement is thought to lead to an increased incidence of arthrosis of the mid or hindfoot and is seen in up to 95.8% of patients with ankle OA, with the subtalar joint being the most commonly and severely affected [13].…”

Complications of Ankle Fusion for Treating Late Sequelae of Ankle Injuries

“…Therefore, whether the adjacent joint degeneration was associated with patient's competent symptoms still lacked sufficient evidence. Nevertheless, it was clear that placing the ankle fusion in the coronal neutral position with coronal plane mildly exhibiting valgus might reduce the chance of adjacent joint degeneration 27,28) . …”