The Journal of Bone and Joint Surgery 83:219 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Long-Term Results Following Ankle Arthrodesis for Post-Traumatic Arthritis
Lisa M. Coester, MD,
Charles L. Saltzman, MD,
John Leupold, MD and
William Pontarelli, MD
Investigation performed at the Department of Orthopaedic
Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Lisa M. Coester, MD
Charles L. Saltzman, MD
John Leupold, MD
William Pontarelli, MD
Departments of Orthopaedic Surgery (L.M.C., C.L.S., J.L., and W.P.),
LL-JPP, and Biomedical Engineering (C.L.S.), LL-JPP 01017, University
of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA
52242. E-mail address for C.L. Saltzman: charles-saltzman{at}uiowa.edu
No benefits
in any form have been received or will be received from a commercial
party related directly or indirectly to the subject of this article. No
funds were received in support of this study.A video supplement
to this article is available from the Video Journal of Orthopaedics.
A video clip is available at the JBJS web site, www.jbjs.org. The Video
Journal of Orthopaedics can be contacted at (805) 962-3410, web
site: www.vjortho.com.
Background: Ankle arthrodesis is considered
by many to be the standard operative treatment for end-stage ankle arthritis;
however, the long-term effect of ankle arthrodesis on other lower-extremity
joints remains largely unknown. The purpose of this study was to perform
a clinical and radiographic review to determine the effect of ankle
arthrodesis on the development of osteoarthritis in other lower-extremity joints.
Methods: Twenty-three patients who had had an isolated ankle
arthrodesis for the treatment of painful post-traumatic arthritis
of the ankle were followed for a mean of twenty-two years (range,
twelve to forty-four years) after the operation. Each completed standardized,
self-reported outcome questionnaires (the Foot Function Index, Western
Ontario and McMaster University Osteoarthritis Index [WOMAC], and
Short Form-36 [SF-36]), was examined clinically by two of the investigators,
and underwent complete radiographic examination of the knee, ankle,
and foot bilaterally. The radiographic grade of osteoarthritis was
determined for each joint, and the levels of overall activity limitation,
pain, and disability were determined for each patient from the clinical
findings and questionnaire information.
Results: Osteoarthritis of the ipsilateral subtalar
(p < 0.0001), talonavicular (p < 0.0001), calcaneocuboid (p < 0.0001),
naviculocuneiform (p = 0.0012), tarsometatarsal (p = 0.0009), and
first metatarsophalangeal joints (p = 0.0012) was consistently more severe
than the osteoarthritis of those joints on the contralateral side.
Osteoarthritis did not develop more frequently in the ipsilateral
knee or lesser metatarsophalangeal joints than it did on the contralateral
side. Significant differences between the two sides were found with
regard to overall activity limitation (p < 0.0001), pain (p < 0.0001),
and disability (p < 0.0001), with the involved side consistently
more symptomatic.
Conclusions: To our knowledge, the present series
represents the longest follow-up study of ankle arthrodesis to date. Our
cohort of patients all had isolated post-traumatic ankle arthritis,
and each underwent a successful isolated ankle arthrodesis. At a
mean of twenty-two years, the majority of the patients had substantial,
and accelerated, arthritic changes in the ipsilateral foot but not
the knee. They were often limited functionally by foot pain. Although
ankle arthrodesis may provide good early relief of pain, it is associated
with premature deterioration of other joints of the foot and eventual
arthritis, pain, and dysfunction.
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