Long-term results following ankle arthrodesis for post-traumatic arthritis.

BACKGROUND: Ankle arthrodesis is considered by many to be the standard operative treatment for end-stage ankle arthritis; however, the long-term effect of ankle arthrodesis on other lower-extremity joints remains largely unknown. The purpose of this study was to perform a clinical and radiographic review to determine the effect of ankle arthrodesis on the development of osteoarthritis in other lower-extremity joints. METHODS: Twenty-three patients who had had an isolated ankle arthrodesis for the treatment of painful posttraumatic arthritis of the ankle were followed for a mean of twenty-two years (range, twelve to forty-four years) after the operation. Each completed standardized, self-reported outcome questionnaires (the Foot Function Index, Western Ontario and McMaster University Osteoarthritis Index [WOMAC], and Short Form-36 [SF-36]), was examined clinically by two of the investigators, and underwent complete radiographic examination of the knee, ankle, and foot bilaterally. The radiographic grade of osteoarthritis was determined for each joint, and the levels of overall activity limitation, pain, and disability were determined for each patient from the clinical findings and questionnaire information. RESULTS: 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. Significant differences between the two sides were found with regard to overall activity limitation (p<0.0001), pain (p<0.0001), and disability (p<0.0001), with the involved side consistently more symptomatic. CONCLUSIONS: To our knowledge, the present series represents the longest follow-up study of ankle arthrodesis to date. Our cohort of patients all had isolated post-traumatic ankle arthritis, and each underwent a successful isolated ankle arthrodesis. At a mean of twenty-two years, the majority of the patients had substantial, and accelerated, arthritic changes in the ipsilateral foot but not the knee. They were often limited functionally by foot pain. Although ankle arthrodesis may provide good early relief of pain, it is associated with premature deterioration of other joints of the foot and eventual arthritis, pain, and dysfunction.

The long-term follow-up of ipsilateral tibial and femoral diaphyseal fractures.

Twenty-nine of 45 patients who had ipsilateral femoral and tibial shaft fractures were evaluated clinically and roentgenographically to correlate treatment method with bony alignment and functional outcome. The results included: (1) limitation of sports activities in patients whose knee ligaments were injured, followed by both instability and thigh atrophy; (2) a direct relationship between the postunion malalignment of the tibia and ankle motion; and (3) a high rate of life threatening complications (thromboembolic, pneumonia, death) and a slower rate of tibial union associated with treatment by closed methods.

Ambulatory dynamic patellar traction for patellar reconstruction.

When severe adjacent soft tissue injury precludes early operative repair of the patellar tendon, proximal migration of the patella and secondary quadriceps contracture may occur. Ambulatory dynamic patellar traction employs a cast brace assembly that prevents or corrects early proximal migration of the patella. The cast brace assembly incorporates a transverse threaded Steinmann pin through the patella, wire loops on the leg section of a cast brace, rubber band traction between the Steinmann pin and the wire loops, and drop lock knee hinges. The use of drop lock hinges allows passive knee motion when the lock is released and ambulation with a stable knee when the hinge is locked. Application of the dynamic ambulatory traction method is employed in the case of a 21-year-old man who sustained a severe electrical burn to the knee with loss of anterior soft tissue, including the patellar tendon. The prescribed traction method corrected early proximal migration of the patella prior to infrapatellar tendon reconstruction.