The Journal of Bone and Joint Surgery (American). 2009;91:575-583.
doi:10.2106/JBJS.H.00559
© 2009 The Journal of Bone and Joint Surgery, Inc.
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The Role of Pantalar Arthrodesis in the Treatment of Paralytic Foot Deformities

A Long-Term Follow-up Study

Stefanos Provelengios, MD1, Kyriakos A. Papavasiliou, MD2, Margaritis J. Kyrkos, MD3, John M. Kirkos, MD3 and George A. Kapetanos, MD4

1 54 Poseidonos Avenue, 17562 Palaio Faliro, Greece
2 3 Natalias Mela Street, 546 46 Thessaloniki, Greece. E-mail address: kyrpap2005{at}yahoo.com
3 138 Al. Papanastasiou Street, 54249 Thessaloniki, Greece
4 8 25th Martiou Street, 552 36 Panorama, Thessaloniki, Greece

Investigation performed at the 3rd Orthopaedic Department, Aristotle University of Thessaloniki Medical School, "Papageorgiou" General Hospital, Thessaloniki, Greece

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Pantalar arthrodesis is considered by many to be the final operative option before amputation for the treatment of paralytic foot deformities. The aim of the present study was to evaluate the long-term results of pantalar arthrodesis with regard to its impact on the adjacent joints and the walking ability of patients with paralytic foot deformities.

Methods: Twenty-four patients (seventeen men and seven women) who underwent a one-stage pantalar arthrodesis between 1953 and 1973 for the treatment of sequelae of poliomyelitis were reevaluated. All patients underwent a physical and radiographic examination, and all completed the Short Form-36 questionnaire and a pantalar arthrodesis-specific questionnaire.

Results: The average age of the patients was twenty years at the time of the operation and 57.2 years at the time of the latest evaluation. The average duration of follow-up was 37.2 years. Eleven patients had development of immediate postoperative complications, including wound-healing problems (nine) and infections (two). The long-term results, however, were good (mean Short Form-36 scores, 73 of 100 points [overall], 51.5 points [physical functioning], and >70 points [all other domains]). Sixteen patients experienced repeated episodes of ipsilateral knee pain; most (fifteen) of these patients experienced a gradual onset of this pain, starting at an average of 20.8 years (range, fifteen to thirty years) postoperatively. The position of the fused ankle did not appear to have a significant impact on the development of ipsilateral knee pain or the time interval between the pantalar arthrodesis and the onset of ipsilateral knee pain.

Conclusions: Pantalar arthrodesis effectively stabilizes the ankle, hindfoot, and midfoot in patients with severe paralytic deformities. Even though most patients can be expected to have development of osteoarthritis of the ipsilateral knee, it seems that a successfully performed pantalar arthrodesis in carefully selected cases is a reliable operative option offering a strong and stable foot that will function well for many years.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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