What is the clinical and radiographic outcome of arthrodeses at the hindfoot and at the ankle more than 10 years postoperatively?
Between 1968 and 1988, 155 arthrodeses (ankle joint, triple arthrodeses, subtalar, pantalar and talonavicular arthrodeses) were performed on 147 patients. Indications for arthrodesis were posttraumatic arthritis, congenital deformity, idiopathic degenerative arthritis and rheumatoid arthritis. A variety of internal fixation devices or no internal fixation were used. 79 patients with 82 arthrodeses were reexamined clinically and radiographically, after 11.1 years on average. Static and dynamic foot print measurements were recorded with a capacitive sensor system. Another 26 patients with 27 arthrodeses replied to a questionnaire.
Subjectively, the average pain score improved significantly. The overall function score improved only slightly. Results were inferior in the talonavicular arthrodesis. Radiographic evaluation revealed bony union in only 59 percent of the arthrodeses, one third at the talonavicular joint. Secondary degenerative arthritis of the foot and ankle occurred in 107 joints of the 82 feet. Evaluation of dynamic foot pressure measurements revealed an overall prolonged weightbearing on the midfoot region.
An unacceptably low rate of bony union in some locations, a high incidence of secondary degenerative changes at neighboring joints, and a persistent abnormality of the plantar weightbearing pattern in the operated feet demonstrate unsatisfactory results with the techniques used more than 10 years ago. We now recommend stable internal fixation with optimum adaptation of the bone surfaces of the arthrodesis.