Does osteoarthritis of the ankle joint progress after triple arthrodesis? A midterm prospective outcome study.
BACKGROUND
Debate exists regarding the effect of triple fusion on the development of osteoarthritis (OA) of the ankle joint. The midterm outcome after triple arthrodesis and the prevalence of OA following triple arthrodesis are reported in this study. The role of alignment in the development of OA was investigated.


METHODS
Seventy five patients (87 feet) were evaluated in 2003 and of these, 48 patients (55 feet) were available for second evaluation in 2008. X-rays of the ankles and feet were made prior to surgery, in 2003 and in 2008, and the level of osteoarthritis (OA) was graded with the Kellgren and Lawrence score. Of all postoperative X-rays, the AP and lateral talo first metatarsal angle X-rays were compared. Also, standardized digital photos were made to assess the geometry/alignment. The Foot Function Index (FFI) and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were completed. In order to investigate the role of the underlying alignment on the aggravation of ankle osteoarthritis, patients were divided into a 'varus' and a 'valgus' group based on the indication for surgery.


RESULTS
The outcome scores (AOFAS and FFI) after triple arthrodesis remained stable in the present 7.5-year follow-up study. An important increase of OA of the ankle was not established, 58% of the patients showed no aggravation, 31% one-grade and 2% two-grade increase of OA. A trend was found (P=.063) towards aggravation of OA of the ankle in patients of the varus group with the highest medial arches (persistent cavovarus deformity).


CONCLUSIONS
This study reports minor, not statistically significant, changes of the ankle joint following triple arthrodesis after 7.5 years. Clinical outcome remained stable in time. Clinical relevance It seems that triple arthrodesis as such does not lead to major osteoarthritis of the ankle, given that adequate alignment of the hindfoot is achieved.


METHODS
Level II, retrospective study.
Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands. Electronic address: chrisaarts@gmail.com.
Chris A M
CA
Aarts
Sint Maartenskliniek Research, Nijmegen, the Netherlands.
Petra J C
PJ
Heesterbeek
Department of Orthopaedics, Bernhoven Ziekenhuis, Uden, the Netherlands.
Perry E M
PE
Jaspers
Department of Orthopaedics, Maartenskliniek Woerden, Woerden, the Netherlands.
Mark
M
Stegeman
Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands.
Jan Willem K
JW
Louwerens
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome