Clinical outcome after primary triple arthrodesis

Background: To analyze the effects of multiple preoperative, intraoperative , and postoperative factors on the intermediate results of triple arthrodes is,,ve focused on preoperative deformity, preoperative diagnosis, degree of clinical and radiographic correction, and arthritis of the ankle, Methods: Between 1987 and 1995, 160 patients were managed with a total of 1 83 triple arthrodeses. Patients who had an infection or neuroarthropathy or who were managed with a revision arthrodesis were excluded from our study. Of the 160 patients, 111 (132 feet) who had been followed for a minimum of two years formed our study group. Each patient had an arthrodesis with rig id screw fixation and realignment of the joint surfaces without resection o f wedges. The average duration of follow-up was 5.7 years (range, 2.0 to 10 .8 years). Results: As seen radiographically, arthritis of the ankle was significantly more severe postoperatively than preoperatively (p < 0.01), although patie nt satisfaction was not associated with the presence of arthritis, On a sca le (not a visual analog) of 0 (not satisfied) to 10 (completely satisfied), overall satisfaction averaged 8.3 points (range, 0 to 10 points). The post operative modified ankle-hindfoot score of the American Orthopaedic Foot an d Ankle Society averaged 60.7 points (range, 0 to 94 points). There was a s ignificant association (p = 0.001) between satisfaction of the patient and postoperative alignment. Ten patients had a fetal of eleven complications: four superficial wound problems, three nonunions, one case of superficial p eroneal neuritis, one case of Charcot-like neuroarthropathy of the foot tin a patient in whom diabetes developed during the followup period), one rupt ure of the Achilles tendon, and one case of peroneal tenosynovitis, Of the 111 patients, 101 (91 percent) stated that they would have the procedure ag ain under similar circumstances, and this response was independent of the p reoperative diagnostic or deformity group. Conclusions: Triple arthrodesis for the treatment of various deformities an d etiologies is effective in relieving pain and improving functional defici ts, Although a high prevalence of subsequent arthritis of the ankle was not ed clinically and radiographically, we could detect no association between satisfaction of the patient and arthritis.