Further hindfoot procedures following ankle arthrodesis versus total ankle arthroplasty : does arthroplasty really protect the hindfoot?

Abstract

This study sought to compare the long-term rates of all procedures for symptomatic hindfoot arthritis following total ankle arthroplasty (TAA) and ankle arthrodesis (AA). We performed a retrospective review of all patients at our centre who had undergone a TAA or AA since January 2002. Case notes and imaging were reviewed and all instances of hindfoot treatment (injections or surgical procedures) noted. Patients were excluded if they had no documentation, were followed up at other hospitals, had previous hindfoot arthrodesis, or were having staged surgeries at the time of index treatment. A total of 153 AA cases and 275 TAAs were eligible. The mean age was 57 years (14 to 89), and the mean time to follow-up was 12 years (1 to 21). Chi-squared tests were used to compare the cohorts. Overall, 14.5% (n = 39) of TAA patients went on to have further procedures to the hindfoot joints, whereas 24.2% (n = 37) of arthrodesis patients had further procedures (p = 0.014). There was also a significant difference in the number of patients progressing to arthrodesis of a further hindfoot joint between groups (TAA, 4% (11/275) and arthrodesis, 14% (21/153); p < 0.001). Data from our retrospective study appear to suggest that, compared with AA, TAA might be more protective of symptomatic change of hindfoot joints. Patients with TAA had fewer hindfoot arthrodeses than those with AA, and also fewer procedures of any form, including injections.