Review Question - QID 211418

After ankle arthrodesis, the most common joint to undergo postfusion arthrosis is the subtalar joint. Substantial nonphysiologic motion occurs in the subtalar joint after an ankle fusion, considered a significant contributory factor.

Ankle arthrodesis is considered by many to be the standard operative treatment for end-stage ankle arthritis. However, in the long term, the adjacent joints of the hindfoot, midfoot, and forefoot compensate by increasing their motion. This may result in accelerated development of arthrosis in these joints. Ankle arthroplasty, by retaining tibiotalar joint motion, may be protective from the development of adjacent joint arthritis.

Haddad et al. performed a systematic review of the literature comparing the intermediate and long term outcomes of ankle arthroplasty and ankle arthrodesis. The systematic review identified total ankle arthroplasty in a total of 852 patients and ankle arthrodesis in a total of 1262 patients. The study found similar results between the groups in regards to patient-reported outcomes, revision free survival, and complications.

Coester et al. analyzed the long-term outcomes following ankle arthrodesis for post-traumatic arthritis. They compared their findings to the contralateral limb with an average follow up of 22 years. Osteoarthritis of the ipsilateral subtalar (p<0.0001), talonavicular (p<0.0001), calcaneocuboid (p<0.0001), naviculocuneiform (p = 0.0012), tarsometatarsal (p = 0.0009), and first metatarsophalangeal joints (p = 0.0012) was consistently more severe than the osteoarthritis of those joints on the contralateral side. Osteoarthritis did not develop more frequently in the ipsilateral knee or lesser metatarsophalangeal joints than it did on the contralateral side.

Figure A shows AP and mortise images status post ankle arthrodesis using an all screw construct with successful union.

Incorrect answers:
Answer 1: Postoperative nonunion is the most common complication following ankle arthrodesis, but this patient has achieve successful union.
Answer 2: Avascular necrosis of the talus is a rare following ankle arthrodesis.
Answer 4: Knee arthritis does not occur at a higher rate on the ipsilateral limb following ankle arthrodesis.
Answer 5: Ankle arthritis has not been found to occur at a higher rate on the contralateral limb following ankle arthrodesis.