COMPRESSION ARTHRODESIS OF THE RHEUMATOID ANKLE AND HINDFOOT

The reported frequency of involvement of the rheumatoid ankle and hind foot varies between 9% and 70%. Fusion of the ankle joint, the subtala r, talonavicular, or calcaneocuboidal joint (Chopart's joint) or all o f them is the preferred method of treatment for severe rheumatoid invo lvement causing pain, instability, and/or severe deformity. Ankle arth roplasty is indicated rarely. Pantalar arthrodesis is performed more f requently than talonavicular fusion or ankle fusion. Reported rates of fusion after compression arthrodesis of the ankle joint vary from 65% to 90%, averaging 80% to 85%. Higher success rates of as high as 95% were obtained with internal lag screw fixation as proposed by Wagner. The result of various combinations of arthrodesis (n = 54) of the ankl e joint, the subtalar joint, and Chopart's joint in 43 patients with r heumatoid arthritis operated on in a 10-year period from 1984 through 1993 are presented. In all cases internal fixation by lag screws accor ding to Wagner was used with a modified lateral approach incorporating osteotomy of the distal fibula. The technique is described in detail. Solid fusion was obtained in 21% of the cases after 8 weeks, in 69% o f the cases after 12 weeks, and in 92% of the cases after 16 weeks. In 8% (3 patients) revision because of delayed union or nonunion eventua lly led to bony fusion. Postoperative pain, walking capacity, gait, an d the subjective outcome were assessed. Complications occurred in 16%, revision was performed in 11.6% of the cases; in all cases healing wa s obtained. Overall patient satisfaction was 93%.