Factors Affecting the Outcomes of Uncomplicated Primary Open Ankle Arthrodesis

• Published in: Foot & ankle international Vol. 36; no. 10; pp. 1170 - 1179
• Main Authors: Chalayon, Ornusa, Wang, Bibo, Blankenhorn, Brad, Jackson, J. Benjamin, Beals, Timothy, Nickisch, Florian, Saltzman, Charles L.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-10-2015
• Subjects: Adult; Age Factors; Aged; Analysis of Variance; Ankle Joint - diagnostic imaging; Ankle Joint - physiopathology; Ankle Joint - surgery; Arthrodesis - adverse effects; Arthrodesis - methods; Body Mass Index; Cohort Studies; Comorbidity; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Osteoarthritis - diagnostic imaging; Osteoarthritis - surgery; Osteoporosis - diagnosis; Osteoporosis - epidemiology; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Radiography; Regression Analysis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Time Factors; Treatment Outcome; ankle arthrodesis; ankle nonunion; ankle fusion; subtalar fusion
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100715587045

Background:
The objective of this study was to identify factors influencing operative outcomes in straightforward, uncomplicated open ankle fusions.
Methods:
We reviewed all primary open ankle fusions conducted at 1 institution over an 11-year period to identify straightforward, uncomplicated open ankle fusions. Inclusion required a minimum of 6 months follow-up. Patients were excluded for neuropathic arthropathy, insensate limb, failed total ankle replacement, simultaneous arthrodesis of the subtalar joint, or fusions performed within 1 year of injury to salvage failed fixation and painful function due to (1) open fractures, (2) segmental bone loss greater than 1 cm, (3) infection, or (4) talar body fractures. The primary outcome variable was radiographic union at 6 months. Other operative complications were analyzed as secondary outcomes. Five hundred twenty-eight ankle fusion surgeries were performed on 440 patients at 1 institution during the study period. Two hundred fifteen surgeries met inclusion/exclusion eligibility criteria for uncomplicated open ankle fusions.
Results:
The overall union rate was 91%. In this cohort of uncomplicated open ankle fusions, bivariate analysis over a broad range of potential factors and further focused multivariate analysis found that nonunion was more than 3 times more likely to occur after previous subtalar fusion, and 2 times more likely to occur in patients with preoperative varus ankle alignment. The rate of reoperation was 19%, with nonunion revision as the leading reason, followed by hardware removal and incision and drainage for presumed infection. Diabetes was not a significant risk factor of either deep or superficial infection.
Conclusion:
Open ankle fusion failed in 9% of uncomplicated ankles with arthritis. Patients who had an open ankle fusion done after previous subtalar joint fusion, as well as those who had preoperative varus ankle alignment, had a significantly higher rate of nonunion.
Level of Evidence:
Level III, retrospective comparative study.