Secondary Arthrodesis After Total Ankle Arthroplasty

Area of Science:

• Orthopedic surgery
• Biomechanical engineering

Background:

• Progressive arthritis or deformity may necessitate hindfoot fusion after total ankle replacement (TAR).
• The impact of TAR on hindfoot biomechanics and blood supply, and its effect on subsequent fusion, remains unclear.

Purpose of the Study:

• To evaluate the safety and effectiveness of hindfoot arthrodesis after TAR.
• To compare fusion rates and outcomes of hindfoot arthrodesis post-TAR versus subtalar fusion post-ankle arthrodesis.

Main Methods:

• Retrospective review of 1001 primary TARs, identifying 26 patients who underwent secondary hindfoot arthrodesis.
• Comparison with 13 patients who had subtalar fusion after ankle arthrodesis.
• Analysis of clinical outcomes, fusion rates, complications, and time to healing.

Main Results:

• 2.6% of TAR patients required secondary hindfoot fusion (subtalar, talonavicular, or triple arthrodesis).
• 92.3% of these secondary fusions achieved union, with significant improvement in pain and function.
• Hindfoot arthrodesis post-TAR showed a higher fusion rate than subtalar fusion post-ankle arthrodesis.

Conclusions:

• Hindfoot arthrodesis is a safe and effective procedure following TAR for managing arthritis and deformity.
• This approach leads to improved patient function and pain relief.
• Higher fusion rates were observed in the hindfoot arthrodesis group post-TAR compared to the control group.