Comparison of Non-Union and Complication Rates in Primary versus Revision Tibiotalar Arthrodesis

Abstract

Category: Ankle Arthritis Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. Patients with a nonunion often undergo revision ankle arthrodesis, as it is the most common salvage procedure in this situation. To date, only a few studies have evaluated outcomes in patients with revision ankle arthrodesis. The purpose of this clinical study is to directly compare the rate of union and complications in primary versus revision tibiotalar arthrodesis. The hypothesis of this study was that there would be no difference in rate of union and complications between primary and revision ankle arthrodesis. Methods: This is a retrospective review of 455 consecutive patients that underwent either primary or revision tibiotalar arthrodesis between March 2002 to November 2014. Three-hundred eighty-five patients underwent primary arthrodesis and 70 patients underwent revision arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: Average age of the patients was 56 +/- 15 years (range 18-89). The mean follow-up time was 38.3 +/- 27.4 months (range 12-150.4 months). All patients had a minimum follow-up of 12 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, patients were further assessed with a computerized tomography scan. The nonunion rate of patients who had primary arthrodesis was 37/385 (9.6%) and revision arthrodesis was 6/70 (8.5%) (p=0.74) (Table 1). Additionally, there was not a significant difference between those who had primary versus revision ankle arthrodesis surgery in rate of wound complication, return to the operating room, and post-operative DVT (Table 2). There were no major complications in this study. Conclusion: This is the largest study to directly compare union rates and complication rates in patients who underwent primary versus revision ankle arthrodesis. In this study, primary versus revision tibiotalar arthrodesis does not affect union rate, time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative DVT.