Adjacent subtalar (STJ) or talonavicular (TNJ) joint arthritis poses a dilemma in end stage ankle arthritis. The Canadian Orthopaedic Foot PG – 25.2; p=0.89). SF36 PCS scores improved from 32.9 pre-operatively to 42.2 at LFU for FG and from 33.9 to 40.0 for PG; differences pre-operatively and at LFU were not significant (p=0.51, p=0.26, respectively). Both groups achieved their best mean scores across all measurement scales at 2 years post-operatively. Results from multivariant analyses controlling for demographics, comorbidities, surgeon, TAA implant type, and pre-operative score showed no significant difference in mean AOS scores at LFU between the two Groups. Reoperations in PG included 2 Code 3 procedures (hindfoot fusion) and 2 Code 9 procedures (revision of metal components). FG had no Code 3 procedures and no Code 9 procedures. In COFAS Type 4 ankle arthritis cases with adjacent hindfoot arthritis undergoing TAA, our data suggests preservation of hindfoot joints yields similar outcomes to fusion of the hindfoot while potentially avoiding greater operative time, immobilization period, and additional wound/hardware risks associated with concomitant hindfoot fusion. However, preservation carries the risk of requiring future reoperation for hindfoot fusion, as seen in 3% of our cases, though this may be countered by the risk of nonunion requiring reoperation when hindfoot fusion is performed primarily. Our results suggest that deferral of hindfoot fusion is a reasonable option in COFAS Type 4 ankles undergoing TAA.
Arafah et al. (Wed,) studied this question.