Ankle fusion attributable to posttraumatic arthrosis: a long-term followup of 48 patients

The subjective, clinical, functional, and radiologic long-term results of 48 patients after tibiotalar arthrodesis done for posttraumatic and isolated arthrosis of the ankle are reported. After an average followup of 9.3 years, good and very good results were achieved in 92% for subjective parameters and in 73% for clinical and functional parameters as reflected in the American Orthopaedic Foot and Ankle Society ankle and hindfoot score. Fusion of the ankle in a position greater than 5 degrees plantar flexion was correlated with a worse late clinical outcome monitored by the American Orthopaedic Foot and Ankle Society ankle and hindfoot score. At the followup, average tarsal mobility in the surgically treated foot was reduced to 54% of the contralateral side and that loss of tarsal mobility led to a poorer clinical outcome. However, a high incidence of subsequent arthrosis in the adjacent joints of the foot seems not to be completely avoidable in the long-term. The subtalar joint had moderate and severe arthrosis in 47% of patients. Long-term outcome was worse in these patients compared with patients with mild or without degenerative changes in this joint. The current study justifies the value of ankle fusion as a surgical treatment option in patients with end-stage arthrosis in the ankle, provided precise intraoperative positioning of the arthrodesis and the importance of the subtalar joint, are given due consideration.