TRIPLE ARTHRODESIS IN OLDER ADULTS - RESULTS AFTER LONG-TERM FOLLOW-UP

We studied the results for seventeen patients (eighteen feet) who had had a triple arthrodesis at an average age of sixty-six (range, fifty-two to eighty years). There were twelve women and five men. The procedures had been performed to correct deformities of the hindfoot and midfoot caused by an untreated rupture of the posterior tibial tendon in ten patients; by rheumatoid arthritis in three patients (four feet); and by neuropathic arthropathy (associated with diabetes mellitus), trauma, old poliomyelitis. and a stroke in one patient each. The average duration of follow-up was forty-two months (range, twenty-seven to 156 months). At the most recent follow-up examination, three patients had a non-union (one, of the talonavicular joint and two, of the calcaneocuboid joint), six patients (seven feet) had progressive degenerative joint disease involving the ankle, seven had progressive degenerative changes in the mobile joints of the feet, two had had an infection but both infections had healed, and one had had postoperative collapse of the foot because of premature, unauthorized weight-bearing. In one patient, a staple across the subtalar joint had been removed because of pain caused by impingement of the staple on the tip of the fibula. Over-all, fourteen of the seventeen patients were satisfied with the result of the operation. All seventeen had less pain postoperatively, but eleven still had some discomfort. The data indicate that triple arthrodesis in older patients relieves or lessens pain; however, because of its technical difficulty and the relatively high rate of postoperative complications in the patients in the current study, it should be used only as a salvage operation for a painful, unstable foot or a foot that has a fixed, disabling deformity.