title: Surgical treatment of hindfoot inflammatory diseases: 107 arthrodesis.
abstract: BACKGROUND
  In rheumatoid diseases, hindfoot arthrodesis abolishes pain and corrects deformity. The choice between selective and double arthrodesis depends on whether the hindfoot malalignment is fixed or not. Indications for surgery are well codified. The various types of arthrodesis have never been assessed together on a large series. We here report a series that is substantial in numbers and in follow-up.
  
  
  METHODS
  A continuous single-center retrospective study included patients with native hindfoot inflammatory disease treated by arthrodesis between 1996 and 2009.
  
  
  RESULTS
  Around 80% of patients were followed up, for a mean 7 years. Fifty-four isolated talonavicular arthrodeses, 14 talocalcaneal arthrodeses and 39 double arthrodeses were performed. 96% of patients had rheumatoid arthritis and 4% spondylarthritis. 62% were completely pain-free at follow-up. The satisfaction rate was 91% and mean AOFAS score 70%. 6% of patients showed symptomatic non-union, mainly associated with talonavicular arthrodesis. In 22% of double arthrodeses and 11% of talonavicular arthrodeses, ankle status required surgical revision. In double arthrodesis, there was no correlation between hindfoot deviation and secondary deterioration in ankle status. Talocalcaneal arthrodesis was associated with radiologic hindfoot varus, both preoperatively and at follow-up.
  
  
  CONCLUSIONS
  Non-union was the main complication in talonavicular arthrodesis. The rate of secondary ankle surgery was significantly elevated in double arthrodesis. These findings support Suckel's cadaver studies, which, in 2007, reported early deterioration in ankle status in double arthrodesis, due to mechanical overloading. Talocalcaneal arthrodesis proved reliable and simple, free of major complications and with a 100% satisfaction rate.
  
  
  CONCLUSIONS
  Double arthrodesis showed the greatest benefit in terms of restoring foot architecture, but was associated with a higher rate of deterioration in ankle status. Preventive double arthrodesis is not recommended in case of isolated arthritis with reducible hindfoot malalignment.
authors.affiliation: Hip, Knee and Foot Surgery Medical Unit, Lapeyronie University Hospital (Montpellier-1 University), 271, avenue Doyen-Gaston-Giraud, 34000 Montpellier, France. marieaudemunoz@yahoo.fr
authors.forename: M A
authors.initials: MA
authors.lastname: Munoz
authors.forename: R
authors.initials: R
authors.lastname: Augoyard
authors.forename: F
authors.initials: F
authors.lastname: Canovas
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D017760:Bone Malalignment / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome