Triple arthrodesis in rheumatoid arthritis

Abstract

Background: Few studies have focused on the long-term results of triple arthrodesis in patients with rheumatoid arthritis. We retrospectively reviewed fusion rate, arthritis of the adjacent joints, clinical outcome, and patient satisfaction.

Materials and methods: Between 1990 and 1998, 28 patients with rheumatoid arthritis were managed with a total of 32 triple arthrodeses. Of the 28 patients, 20 (24 cases) had been followed for 5.2 (range, 4 to 7) years. Fusion was performed with rigid staple fixation and autologous bone graft. Assessment included plain radiographs, CT scans, and various clinical scores.

Results: Complications were limited to superficial wound healing problems in 8 patients (8 cases). No revision surgery was necessary. Radiographically, all feet showed fusion. Progression of arthritis was found in 17 cases, mostly in the midfoot. The visual analogue scale for pain averaged 47 (range, 3 to 94) points. The SMFA scores were 45 (range, 10 to 71) points for dysfunction and 38 (range, 10 to 72) points for bother with a significant association (p < 0.05) between the SMFA- and the AOFAS-Score. The mean Short Form-36 (SF-36) physical component outcomes score was 51 (range, 18 to 98) points and the AOFAS score averaged 70 (range, 40 to 94) points. All patients stated that they would have the procedure again under similar circumstances.

Conclusion: Triple arthrodesis in rheumatoid patients is effective in relieving pain and improving functional deficits. High fusion rates can be expected. There is, however, a high risk for consecutive arthritis of the neighboring joints, especially in the midfoot.