What went wrong in triple arthrodesis? An analysis of failures in 21 patients

Three hundred seven triple arthrodeses were done on 282 patients with rheum atic diseases between 1995 and 1999. Solid and painless fusion was achieved in 261 patients (93%, 286 arthrodeses). Twenty-one arthrodeses (in 21 pati ents) that failed were analyzed. Fourteen (66%) malunions, six (29%) nonuni ons, and one (5%) painful foot without malunion or nonunion were found. Of the failed procedures, valgus alignment was present in 13 feet and varus al ignment was present in eight feet. The most common cause of failure was a m isjudgment in the surgical technique, which occurred in 12 of 21 (57%) pati ents based on inadequate correction and repositioning of hindfoot deformity . In four (19%) patients, additional ankle destruction and instability was overlooked as a cause of malalignment. Revision triple arthrodesis was succ essful in 18 of 21 (86%) patients. Triple fusion offers challenges in surgi cal technique, postoperative treatment, and rehabilitation. Understanding t he complexity of the rheumatic hindfoot is important when performing triple arthrodesis in patients with severe deformities manifesting typically as c alcaneovalgus and pes planus.