Outcomes After Total Ankle Replacement in Association With Ipsilateral Hindfoot Arthrodesis

Abstract

Background: Ipsilateral hindfoot arthrodesis in combination with total ankle replacement (TAR) may diminish functional outcome and prosthesis survivorship compared to isolated TAR. We compared the outcome of isolated TAR to outcomes of TAR with ipsilateral hindfoot arthrodesis. Methods: In a consecutive series of 404 primary TARs in 396 patients, 70 patients (17.3%) had a hindfoot fusion before, after, or at the time of TAR; the majority had either an isolated subtalar arthrodesis (n = 43, 62%) or triple arthrodesis (n = 15, 21%). The remaining 334 isolated TARs served as the control group. Mean patient follow-up was 3.2 years (range, 24-72 months). Results: The SF-36 total, AOFAS Hindfoot-Ankle pain subscale, Foot and Ankle Disability Index, and Short Musculoskeletal Function Assessment scores were significantly improved from preoperative measures, with no significant differences between the hindfoot arthrodesis and control groups. The AOFAS Hindfoot-Ankle total, function, and alignment scores were significantly improved for both groups, albeit the control group demonstrated significantly higher scores in all 3 scales. Furthermore, the control group demonstrated a significantly greater improvement in VAS pain score compared to the hindfoot arthrodesis group. Walking speed, sit-to-stand time, and 4-square step test time were significantly improved for both groups at each postoperative time point; however, the hindfoot arthrodesis group completed these tests significantly slower than the control group. There was no significant difference in terms of talar component subsidence between the fusion (2.6 mm) and control groups (2.0 mm). The failure rate in the hindfoot fusion group (10.0%) was significantly higher than that in the control group (2.4%; p < 0.05). Conclusion: To our knowledge, this study represents the first series evaluating the clinical outcome of TARs performed with and without hindfoot fusion using implants available in the United States. At follow-up of 3.2 years, TAR performed with ipsilateral hindfoot arthrodesis resulted in significant improvements in pain and functional outcome; in contrast to prior studies, however, overall outcome was inferior to that of isolated TAR. Level of Evidence: Level II, prospective comparative series.

Hip, Knee, and Ankle Osteoarthritis Negatively Affects Mechanical Energy Exchange

“…Individuals with ankle OA walked the slowest of all the cohorts, reflecting the deep disability associated with end-stage ankle OA [25,26]. The walking speed in our cohort with ankle OA is similar to those reported for patients with end-stage hip [22,25], knee [25,27], and ankle OA [17,20,21,23,25].…”

Secondary Arthrodesis After Total Ankle Arthroplasty

“…8 The Short Form–36 (SF-36) was used to assess overall health, and the Short Musculoskeletal Function Assessment (SMFA) Foot questionnaires were used to assess patient-reported functional limitations as has been reported previously in TAR. 9,12 Pain was rated using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 100 (maximum pain).…”

The Value of Motion: Patient-Reported Outcome Measures Are Correlated With Range of Motion in Total Ankle Replacement

“…Improvements in PROMs are seen in multiple TAR patient demographics, including those with relatively high body mass index (>35 kg/m 2 ), diabetes, ipsilateral subtalar arthrodesis, and even active smokers. [11][12][13][14] PROMs represent increasingly important instruments for effect measurement as the United States embraces new reimbursement models and relies on PROMs for gauging value. 15,16 This comes with the caveat that PROMs must be validated to justify their utility.…”