Ankle Plus Hindfoot Fusion May Help Patients With Pantalar Arthritis

Managing arthritis in the foot can be difficult. With pantalar arthritis, arthritis in the back of the foot towards the ankle, it can be particularly difficult if it gets to the point that surgery is needed. Right now, it’s common to do a total ankle arthroplasty to help manage the pain. This can involved either resurfacing, rebuilding, or completely replacing the ankle. But, researchers have found that it may be better for the patients if they had a combination surgery that included the arthroplasty with fusion (joining together) of the hind foot, or back of the foot.

In a study done by Kelly L. Apostle and colleagues, 73 patients who had a total ankle arthroplasty and one of two types of fusions were compared with 72 patients who had only the arthroplasty. After following the patients for two years, the researchers found that both groups improved at the same rate. The researchers used the Ankle Osteoarthritis Scale (AOS) and Foot Function Index when they examined the patients at six, 12, and 24 months after their surgery.

However, there were differences in the complication rate. There was a 32 percent complication rate, 16 patients experienced major complications, in the arthroplasty plus fusion group. These included mostly loosening of hardware. It turned out that 30 percent of the patients needed to have repeat surgery, one of whom underwent an amputation below the knee. In the arthroplasty-only group, 42 percent of the patients had complications, half of which were major and mostly related to the hardware. And, 26 percent of the patients needed surgery again.

In conclusion, the researchers found that although the pain relief obtained from both procedures, as well as returning function to the ankle, were similar, the complication rate of the arthroplasty alone was quite a bit higher than the arthroplasty plus fusion group.