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Clinical Outcome After Primary Triple Arthrodesis*†
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Investigation performed at the Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore
J Bone Joint Surg Am, 2000 Jan 01;82(1):47-57
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Background: To analyze the effects of multiple preoperative, intraoperative, and postoperative factors on the intermediate results of triple arthrodesis, we focused on preoperative deformity, preoperative diagnosis, degree of clinical and radiographic correction, and arthritis of the ankle.

Methods: Between 1987 and 1995, 160 patients were managed with a total of 183 triple arthrodeses. Patients who had an infection or neuroarthropathy or who were managed with a revision arthrodesis were excluded from our study. Of the 160 patients, 111 (132 feet) who had been followed for a minimum of two years formed our study group. Each patient had an arthrodesis with rigid screw fixation and realignment of the joint surfaces without resection of wedges. The average duration of follow-up was 5.7 years (range, 2.0 to 10.8 years).

Results: As seen radiographically, arthritis of the ankle was significantly more severe postoperatively than preoperatively (p < 0.01), although patient satisfaction was not associated with the presence of arthritis. On a scale (not a visual analog) of 0 (not satisfied) to 10 (completely satisfied), overall satisfaction averaged 8.3 points (range, 0 to 10 points). The postoperative modified ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society averaged 60.7 points (range, 0 to 94 points). There was a significant association (p = 0.001) between satisfaction of the patient and postoperative alignment. Ten patients had a total of eleven complications: four superficial wound problems, three nonunions, one case of superficial peroneal neuritis, one case of Charcot-like neuroarthropathy of the foot (in a patient in whom diabetes developed during the follow-up period), one rupture of the Achilles tendon, and one case of peroneal tenosynovitis. Of the 111 patients, 101 (91 percent) stated that they would have the procedure again under similar circumstances, and this response was independent of the preoperative diagnostic or deformity group.

Conclusions: Triple arthrodesis for the treatment of various deformities and etiologies is effective in relieving pain and improving functional deficits. Although a high prevalence of subsequent arthritis of the ankle was noted clinically and radiographically, we could detect no association between satisfaction of the patient and arthritis.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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