Purpose of the study: The aim of this study was to evaluate the long-term effect of tibiotalar arthrodesis on function, clinical and radiological tolerance, and subtalar joints.
Material and methods: We reviewed 37 cases of tibiotalar arthrodesis in 27 young patients who were generally manual workers. Their mean age at surgery was 46 years and mean follow-up at review was 12.8 years (range 5-26 years). Functional outcome was assessed with the Duquennoy scale. We reviewed the anterioposterior and lateral weight-bearing views as well as the lateral view in dorsal and forced plantar flexion.
Results: Mean functional outcome was good and very good in 66% of the cases, fair in 30% and poor in one case. Total pain relief had been achieved in 45% of the cases with a mean walking distance of 1500 m without crutches. Residual mobility at last follow-up was 13 degrees for the mediotarsal joint. This mobility allowed the arthrodesed foot to adapt to gait. Radiologically, fusion had been achieved in 83% of the cases within 3 months. The overall functional score fell off proportionally with the degree of arthrodesis valgus starting at 5 degrees. Likewise pes equinus > 10 degrees led to pain and reduced motion. The subtalar joints were affected in all cases, leading to poor adaptation of the foot on uneven ground. Grade 1 osteoarthritis affected the mediotarsal joint and was more marked in case of equine fixation.
Discussion: Our results are similar to those reported in the literature. We had 4 cases of nonunion in patients with risk factors previously discussed in the literature.
Conclusion: Arthrodesis remains a useful method for treating talocrural osteoarthritis, providing good long-term results. The position of the fixation should be 90 degrees in the sagittal plane and 0 degrees to 5 degrees valgus in the frontal plane.