LONG-TERM COURSE OF A COHORT OF 25 TALOCRURAL ARTHRODESES: COMPARATIVE OUTCOME AT 7 AND 20 YEARS

Abstract

Purpose: The aims of this work were to assess very long-term outcome and to assess functional course of talocrural arthrodesis as well as to determine the clinical and radiological impact on adjacent joints.

Material and method: Fifty-two talocrural arthrodeses performed in 52 patients between 1963 and 1981 served as the reference population for this study. Clinical and radiological assessment of this series of patients was conducted in 1983, then again in 1999. Twenty-five talocrural arthrodeses in 25 patients were reviewed at a mean 23 years (19 to 36 years) (six patients were lost to follow-up, 20 had died, one had had leg amputation. The arthrodesis had been performed for advanced degenerative joint disease or to correct for post-traumatic deformity, or in two cases, for neurological varus equinus. Functional outcome was evaluated on the Duquennoy and Stahl score (100 points) that was also used for the intermediary assessment. Radiographic assessment included the position of the arthrodesis, the status of the adjacent joints (subtalar and mediotarsal), and residual motion of the forefoot.

Results: At 23 years follow-up, 13 patients (52%) had good (five patients) or very good (eight patients) function and 12 (48%) had fair function, according to the 100 point scale. There were no patients with poor function. Patients without intercurrent conditions (neurological or heart disease, obesity) had good or very good function in 80% of the cases. Patients were very satisfied in 48% of the cases, having “forgotten” their ankle. At the seven-year follow-up analysis, 15 patients (60%) had a very good (ten patients) or good (five patients) result, seven had a fair result, and three had a poor result. Comparing the 7-year and 23-year assessments did not disclose any significant degradation of the result (p = 0.07). Intercurrent conditions explained the two functional degradations, but there were also three functional improvements over the same period. Talocrural arthrodesis induced stiffness in the subtalar joint in all cases, associated with severe osteoarthritis with little clinical expression. There was a slow degradation of the mediotarsal joint but hypermobility useful for good function was maintained in 45% of the cases (mean 24°). Fair results were related to development of subtalar osteoarthritis, malposition of the arthrodesis in the frontal plane (rear foot varus) and presence of intercurrent conditions (cardiovascular, neurological disease).

Conclusion: Talocrural arthrodesis is a safe and reliable procedure for the treatment of destroyed joints. This palliative surgery can restore satisfactory function which persists in the long term.