Today's News

Thursday, February 13, 1997

Surgeons urged to tell outcomes of triple arthrodesis

Although patients are satisfied with the results of triple arthrodesis, surgeons should advise patients that over time there are deteriorating outcomes from the procedure, including pain from walking, limited functional mobility and the possible need for ambulatory aids, the authors of scientific paper 119 reported Thursday.

In the first long-term study comparing patients' symptom levels, function, arthritis and satisfaction rates after an average 28- and 49- year follow-up, 93 patients (112 feet) were evaluated. Ninety-five of the feet had complete fusion.

"Surprisingly, even though there was overall deterioration, at second follow-up 87 patients were satisfied with their results, and 85 said they would recommend triple arthrodesis as treatment for the same condition," said co-author Charles L. Saltzman, MD. Dr. Saltzman is associate professor, department of orthopaedic surgery, University of Iowa, Iowa City, Iowa.

Patients had triple arthrodesis for a variety of foot difficulties and preoperative deformities. They ranged in age from 5 to 57 years (average: 16 years).

According to Dr. Saltzman, most of the deterioration in outcomes occurred after the first 20 postoperative years. From the first to second follow-up, patients' pain increased from 46 to 72 percent; patients who needed support devices rose from 37 to 71 percent; and patients who used analgesic pain medications increased from 8 to 27 percent.

Also at first follow-up, 92 percent of the patients could walk more than one mile, compared to only 39 percent at final follow-up. One patient, during first follow-up, could walk less than three blocks; during the second follow-up 22 patients could walk less than three blocks.

Fifty-seven patients (67 feet) who had a physical examination in 1973 and 1994, had worse outcomes for postoperative motion, ankle dorsiflexion, supination and pronation. At final follow-up, 52 of the 67 feet had some residual deformity and 28 had callosities.

"During the first follow-up 50 feet were rated good and 17 fair," Dr. Saltzman said. "At final follow-up, 19 feet were rated good; 46, fair; and three poor."

Co-authors of the study are Reginald R. Cooper, MD, associate professor, department of orthopaedic surgery, University of Iowa, Iowa City, Iowa, and Margaret J. Fehrle, MD, Marshalltown Orthopaedics, Marshalltown, Iowa.