ANKLE ARTHRODESIS IN THE PRESENCE OF LARGE CORONAL PLANE DEFORMITY

Abstract

We aim to assess the outcome of ankle arthrodesis performed for painful osteoarthritis in the presence of a coronal plane deformity of 20 degrees or more. To our knowledge this is the first reported series of such a cohort of patients. We have a consecutive and complete series of 24 patients with 26 ankle arthrodeses which were all performed for painful osteoarthritis in the presence of large coronal plane deformity. These patients have a minimum of twelve months clinical follow up. The results showed a low non union rate of 8% (2 ankles). These have subsequently been refused satisfactorily, and were excluded from further analysis. The results of the remaining 24 ankles which united primarily show that they were very pleased with the outcome of their surgery. AOFAS scores were used to measure pain and function both pre operatively and post operatively. These scores showed large improvements for both pain and function, and had a high statistical significance (p< 0.0005). All patients improved in their walking distance and many patients reduced their need for walking aids. Stair climbing ability was also improved in some patients. It is recognised that an ankle arthrodesis usually relieves pain but does not result in a normal gait and full function. We feel that the high level of patient satisfaction in this series was due to the combination of deformity correction, restoring a functional foot position, and achieving a painless ankle. Arthroplasty of the ankle is a good procedure for relief of pain and restoration of function. However In the presence of a large coronal plane deformity ankle arthroplasty is known to fare badly with early failure. Therefore for patients with painful osteoarthritis and a coronal plane deformity of 20 degrees or more, we recommend ankle arthrodesis as the procedure of choice.