Tibiotalar arthrodesis - Is union rate and time to union influenced by preoperative deformity, patient related factors or open/arthroscopic procedure and what do patients perceive?

L. Thomson, R. Issac, K. Khan, A. Best, P. Allen, J. Mangwani

Background: Arthroscopic ankle arthrodesis(AAA) is an established procedure for treatment of end stage ankle arthritis. It has the potential advantage of faster time to union, lower morbidity ,faster rehabilitation, less blood loss and shorter hospital stay when compared to open fusion.The purpose is to analyse if union is affected by deformity, patient related factors and measure PROMS.

Materials and methods: Between January 2005 and December 2015, 124 Ankle Arthrodesis (OAA-27; AAA-97) procedures were performed by fellowship trained foot and ankle surgeons in a single institution. Based on preoperative deformity, (AAA- 28 degree valgus to 26 degrees varus; OAA- 41 degree valgus to 28 degree varus) they were subdivided into 2 groups based upon deformity more than 15 degrees. Union rates, time to union, length of stay, PROMS (EuroQol pain and Johnson´s satisfaction scale).

Results: Mean age of patients was 60years (Range-20-82 years)( Male:Female-92:32).Overall fusion rate was 93% in AAA and 89% in OAA (p=0.4 ).On sub group analysis of the influence of preoperative deformity, there was no difference in union rates of AAA versus OAA. Average time to union was 13.7 in AAA and 12.5 weeks in OAA (p=0.3). Average hospital stay was 2.6 days in AAA and 3.8 days in OAA (p=0.003) 40% had no pain on EuroQol and 32% were completely satisfied with their procedure.

Conclusion: Although both AAA and OAA showed good union rates,hospital stay was significantly shorter in AAA. A larger deformity did not adversely affect union rates in AAA. 40% of patients reported a good outcome for pain relief. Lifestyle risk factors did not have cumulative effect on union. Our study shows that AAA is reproducible method of treating end stage arthritis of tibiotalar joint irrespective of preoperative deformity and patient related factors, however PROMs show there is still areas for improvement, up to 5 years post procedure.