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 Foot/Ankle Test 5: Foot/Ankle February 2005
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The Journal of Bone and Joint Surgery (American). 2004;86:2707-2713
© 2004 The Journal of Bone and Joint Surgery, Inc.

Triple Arthrodesis in Adults with Non-Paralytic Disease

A MINIMUM TEN-YEAR FOLLOW-UP STUDY

Ronald W. Smith, MD1, Wen Shen, MD2, Sarah DeWitt, MD3 and Stephen F. Reischl, DPT, OCS4

1 Balance Orthopaedic Foot and Ankle Center, 2651 Elm Avenue, Suite 205, Long Beach, CA 90806. E-mail address: rsmith{at}memnet.org
2 Orthopedic Associates of Dutchess County, One Webster Avenue, Suite 400, Poughkeepsie, NY 12601
3 Raleigh Orthopedic Clinic, 3515 Glenwood Avenue, Raleigh, NC 27612
4 2650 Elm Avenue, Suite 214, Long Beach, CA 90806

Investigation performed at Long Beach Memorial Medical Center and Balance Orthopaedic Foot and Ankle Center, Long Beach, California

A video supplement to this article is available from the Video Jour-nal 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.

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Memorial Medical Foundation, Long Beach, CA. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (KCI for the Long Beach Memorial Fellowship Fund) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The triple arthrodesis was developed to treat sequelae of neurologic disorders affecting the hindfoot. Today, the typical adult patient undergoing this procedure has degenerative disease, usually not related to a neurologic disorder. The purpose of this study was to investigate the long-term outcome of triple arthrodesis in this patient population.

Methods: Twenty-seven adult patients (thirty-one feet) who had undergone triple arthrodesis for the treatment of chronic hindfoot pain and had been followed for a minimum of ten years completed an outcomes questionnaire, and twenty-two patients (twenty-six feet) were available for physical examination, radiographs, and functional testing. The mean age of the patients who were examined was forty-five years at the time of the surgery, and the mean duration of follow-up of those patients was fourteen years (range, eleven to eighteen years).

Results: Twenty-five (93%) of the patients were satisfied with the result of the treatment. However, only eleven (41%) reported that they could perform moderate activity with mild or no pain in the foot and ankle. Twenty patients (74%) reported moderate-to-severe difficulty with, or an inability to negotiate, uneven surfaces. The mean Short Form-36 (SF-36) physical component outcomes score was 35.2 points, well below the mean of 50 points for the United States population. The SF-36 score was significantly lower for patients with systemic inflammatory disease (primarily rheumatoid arthritis). There was an average 12° (27%) loss of plantar flexion but no significant loss of dorsiflexion compared with the untreated foot. Severe arthrosis developed in seven of the twenty-six ankles, in seven naviculocuneiform joints, and in six tarsometatarsal joints. Some patients had severe arthrosis at more than one level, and three patients later required an ankle arthrodesis. There were no nonunions or revisions of the triple arthrodeses. The average patient performances on the six-minute walk and the 3-m up-and-go functional tests were well below the age-controlled means.

Conclusions: Triple arthrodesis may provide patients with substantial long-term relief of preoperative symptoms. However, there may also be adverse consequences, particularly degenerative changes in adjacent joints, that may be reasons for orthopaedic surgeons to consider alternatives to triple arthrodesis when feasible.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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