Citation: Foot and Ankle International, 2013, March 6th, epub ahead of print
Authors: Ajis A, Tan KJ, Myerson MS
Abstract: BACKGROUND: It is believed that patients with an ankle arthrodesis (AA) have better
outcomes than after a tibiotalocalcaneal (TTC) arthrodesis due to preservation
of subtalar motion. However, there are no studies comparing actual functional
outcomes and patient satisfaction between AA and TTC arthrodesis. METHODS: We retrospectively analyzed patient satisfaction and functional outcomes of
patients after an AA and TTC arthrodesis using a postal survey. A total of 173
patients who underwent TTC and 100 AA patients from 2002 to 2010 were identified
with a minimum of 24 months follow-up. In all, 53 AA and 64 TTC arthrodesis
patients were included in the study, with the remainder lost to follow-up. A
return to activity questionnaire and SF-12 scores were used to compare
functional outcomes. The mean follow-up time was 63 months.
RESULTS: Both groups showed good outcomes with a low visual analogue pain score (2.7
for AA and 2.8 for TTC), high satisfaction score (90.6% for AA and 87.5% for
TTC), and return to work (77.4% for AA and 73.0% for TTC). In all, 84.6% of AA
and 81.0% of TTC patients would have the surgery again. There were no
significant differences between the 2 groups for these parameters. However, when
asked if their desired activity level was met, fewer AA patients met their
desired level (58.5% for AA and 66.5% for TTC, P = .02). AA patients were also
more likely to feel their level was unmet due to the foot and ankle (85.6% for
AA vs 25.7% for TTC, P < .001).
CONCLUSIONS: Both AA and TTC arthrodesis were associated with good functional outcomes and
satisfaction. AA patients had higher postoperative activity expectations and
were less likely to meet them. When they failed to meet these expectations, they
were much more likely to attribute it to their operated ankle. We believe it is
because of the different ways the 2 groups of patients are counseled
preoperatively, which highlights the importance of managing patient
expectations.
LEVEL OF EVIDENCE: Level III, retrospective comparative study.