Long-term follow-up of triple arthrodesis in patients with cerebral palsy

This study was a long-term retrospective review of patients with cerebral palsy (CP) who had triple arthrodeses as children before 1981. The medical records were reviewed, and the patients were requested to return for reevaluation, during which a radiograph, physical examination, and patient questionnaire were obtained. Twenty-four patients who had triple arthrodesis on 35 feet returned for evaluation. Twenty-three feet had planovalgus deformities and 12 equinovarus deformities. Mean age at operation was 14.2 years, with a mean follow-up of 17.8 years (range 11-45 years). Of the 24 patients questioned, 19 were satisfied and five were dissatisfied with their result. Nine patients had occasional pain; one patient reported frequent pain in one foot. Six patients had limited distance ambulation owing to their feet. Radiographic evaluation demonstrated that 43% of the feet had degenerative changes at the ankle joint. Four of six patients reported ambulatory limitation due to pain. Ankle joint range of motion (ROM) and degenerative arthritis were not correlated with pain, distance limitations, residual deformity, or patient satisfaction. Patient satisfaction was predominantly related to persistent pain, especially pain causing distance limitations in ambulation. Patient satisfaction was also strongly correlated with residual deformity. Persistent pain and distance limitation were also strongly correlated with residual planovalgus deformity.