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Patient-Reported Outcomes and Revision Risk Following Total Ankle Replacement With and Without Ipsilateral Hindfoot
Emily Teehan1, Allison L Boden2, Agnes Jones1
1Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA.
Foot & Ankle International
|June 26, 2025
Summary
Total ankle replacement (TAR) with hindfoot fusion shows worse PROMIS scores but similar functional improvement compared to TAR alone. Patients with hindfoot fusion had higher revision rates and persistent mental health burden.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Reconstruction
- Patient-Reported Outcome Measures
Background:
- Hindfoot fusion is a common procedure for arthritis and deformity.
- Concomitant or prior hindfoot fusion occurs in some total ankle replacement (TAR) patients.
- Evaluating outcomes of TAR with ipsilateral hindfoot fusion is crucial for surgical decision-making.
Purpose of the Study:
- To compare Patient-Reported Outcomes Measurement Information System (PROMIS)-based outcomes, revision rates, and radiographic findings between primary TAR with and without ipsilateral hindfoot fusion.
- To test the hypothesis that TAR with ipsilateral hindfoot fusion leads to worse patient-reported and clinical outcomes.
Main Methods:
- Retrospective review of 400 primary TAR patients (with or without ipsilateral hindfoot fusion).
- Analysis of PROMIS domains, radiographs, complications, and revision rates at a minimum 2-year follow-up.
- Multivariate regression models and comparisons of minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) achievement.
Main Results:
- Hindfoot fusion (12.3% of cases) was associated with worse 2-year PROMIS scores in Physical Function, Pain Interference, and Global Mental Health.
- MCID and PASS achievement rates were similar for Physical Function and Pain Interference, but lower for Pain Intensity and Depression/Mental Health in the hindfoot fusion group.
- The hindfoot fusion group had a significantly higher revision rate (10.2% vs. 2.6%).
Conclusions:
- While TAR with hindfoot fusion yields lower absolute PROMIS scores, patients perceive similar meaningful clinical improvement in pain and function.
- Patients with concomitant hindfoot fusion may experience more persistent mental health issues and less improvement in pain intensity.
- Higher revision rates in the hindfoot fusion group warrant consideration in surgical planning.
