title: Clinical and radiographic outcome of revision surgery for failed triple arthrodesis.
abstract: Between 1987 and 1994, we treated 33 patients with surgical revision for failed triple arthrodesis, 28 (29 feet) of whom returned for final examination (mean, 4.4 years; range, 2-7 years). The average age of these 16 women and 12 men was 46 years (range, 14-69 years). Before the revision procedure, patients had undergone nonoperative therapies for an average of 3.7 years (range, 0.5-12 years) and an average of three foot operations (range, 1-6 operations) after the primary triple arthrodesis. All patients were managed with rigid internal fixation via cannulated screws and power staples. Calcaneal osteotomy and/or revision of the transverse tarsal arthrodesis via appropriate saw cuts and bone wedges were used. Iliac crest bone graft was added, when a bone block arthrodesis was required, for those patients with nonunion or ankle impingement. Arthrodesis was achieved in all 29 feet, although 4 patients (4 feet) (14%) required additional procedures for malunion (2 patients), deformity recurrence (1 patient), deep infection (1 patient), and skin graft (1 patient). Comparison of the average pre- (retrospective) and postoperative American Orthopaedic Foot and Ankle Society 94-point hindfoot and ankle scores showed a significant improvement: 31 points (range, 13-61 points) versus 59 points (range, 24-91 points), respectively (P < 0.05). On a scale of 0 to 10 points, average patient satisfaction was 7.8 points (range, 2-10 points). This study demonstrated a satisfactory improvement in patient outcome after surgical correction of failed triple arthrodesis. We conclude that such a revision, although complex, may be attempted to establish a plantigrade foot free of infection and able to wear shoes without and orthosis or brace.
authors.affiliation: Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Haddad
authors.forename: M S
authors.initials: MS
authors.lastname: Myerson
authors.forename: R F
authors.initials: RF
authors.lastname: Pell
authors.forename: L C
authors.initials: LC
authors.lastname: Schon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000842:Ankle / Q000000981:diagnostic imaging*; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D013640:Tarsal Joints / Q000601:surgery*; D016896:Treatment Outcome