Background: The triple arthrodesis was developed to treat sequelae
of neurologic disorders affecting the hindfoot. Today, the typical adult
patient undergoing this procedure has degenerative disease, usually not
related to a neurologic disorder. The purpose of this study was to investigate
the long-term outcome of triple arthrodesis in this patient population.
Methods: Twenty-seven adult patients (thirty-one feet) who had
undergone triple arthrodesis for the treatment of chronic hindfoot pain and
had been followed for a minimum of ten years completed an outcomes
questionnaire, and twenty-two patients (twenty-six feet) were available for
physical examination, radiographs, and functional testing. The mean age of the
patients who were examined was forty-five years at the time of the surgery,
and the mean duration of follow-up of those patients was fourteen years
(range, eleven to eighteen years).
Results: Twenty-five (93%) of the patients were satisfied with the
result of the treatment. However, only eleven (41%) reported that they could
perform moderate activity with mild or no pain in the foot and ankle. Twenty
patients (74%) reported moderate-to-severe difficulty with, or an inability to
negotiate, uneven surfaces. The mean Short Form-36 (SF-36) physical component
outcomes score was 35.2 points, well below the mean of 50 points for the
United States population. The SF-36 score was significantly lower for patients
with systemic inflammatory disease (primarily rheumatoid arthritis). There was
an average 12° (27%) loss of plantar flexion but no significant loss of
dorsiflexion compared with the untreated foot. Severe arthrosis developed in
seven of the twenty-six ankles, in seven naviculocuneiform joints, and in six
tarsometatarsal joints. Some patients had severe arthrosis at more than one
level, and three patients later required an ankle arthrodesis. There were no
nonunions or revisions of the triple arthrodeses. The average patient
performances on the six-minute walk and the 3-m up-and-go functional tests
were well below the age-controlled means.
Conclusions: Triple arthrodesis may provide patients with
substantial long-term relief of preoperative symptoms. However, there may also
be adverse consequences, particularly degenerative changes in adjacent joints,
that may be reasons for orthopaedic surgeons to consider alternatives to
triple arthrodesis when feasible.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.