Subtalar Joint Fusion For STJ OA before vs after Total Ankle Replacement: Does it affect patient outcomes? – A 10 year follow up clinical study

Abstract

Category: Ankle; Hindfoot Introduction/Purpose: There is paucity of literature reporting outcomes in patients who undergo subtalar joint fusion surgery before vs. after having a Total Ankle Replacement (TAR). We aimed to study the PROMs in patients who underwent a staged approach of Subtalar arthrodesis (STJA) followed by TAR vs patients who underwent TAR followed by further STJA surgery. Methods: All patients who underwent a STJA surgery and TAR surgery (in either order) between 2006 and 2010 included in this study. patient reported outcomes including WOMAC (Western Ontario McMasters Osteoarthritis score), SF-36 general health score and patient satisfaction scores were compared between groups. They analysed pre-operatively and at 1, 2, 5 and 10 years post-operatively. Out of 210 TARs performed, 14 patients underwent a two staged procedure between 2006 and 2010 by a single surgeon. 5 patients had STJ fusion after TAR (Group A) and 9 patients had STJ fusion before TAR (Group B). Results: Mean age of Group A and B was 52.5 years and 62.1 years respectively. 1 patient in Group A and 3 patients in Group B were deceased. Both groups reported improvement in scores for WOMAC, SF -36 from pre-op to 1 year post operatively (p < 0.05) and the results plateaued to 5 years with slight decline in scores from 5 to 10 years. At 2 years, Group B reported lower scores for stiffness (9.6±11.7 vs. 64.3 ±27.4) p=0.002, At 5 years, Group A reported lower scores than group B for General health and mental health components of SF-36 scores (p=0.044); however, there was no differences between groups for WOMAC, SF-36 and patient satisfaction outcomes at 10 years post-operatively. Conclusion: There were similar outcomes reported by patients who underwent STJA either before or after TAR at average of 10 year follow up in this series