Retrospective cohort study of 23 patients followed for a mean of 22 years after isolated ankle arthrodesis for post-traumatic arthritis. Using bilateral radiographs (Kellgren and Moore grading), clinical exam, and validated questionnaires, the study asks whether ankle fusion accelerates osteoarthritis in adjacent lower-extremity joints. This is the longest follow-up series of ankle arthrodesis reported at the time of publication.
Ankle arthrodesis has long been considered the gold standard for end-stage ankle arthritis, but prior series had follow-up of only 8–12 years — too short to capture the full cost of the procedure.
This paper establishes the long-term trade-off: ankle fusion reliably eliminates ankle pain but predictably transfers stress to six adjacent foot joints, causing accelerated degeneration over the following two decades.
When counseling a patient before ankle arthrodesis, tell them directly: the ankle will feel better, but expect progressive hindfoot and midfoot arthritis, likely limiting walking distance and requiring walking aids in later years. The knee will be spared.
The finding that talonavicular arthritis drives functional limitation more than any other joint (r=0.79) has a practical implication. Monitor the talonavicular joint at long-term follow-up visits, as its status predicts who will become most disabled.
This data is part of the rationale for considering total ankle replacement in younger, active patients where preserving adjacent joint motion may delay or reduce this degenerative cascade.
Retrospective cohort study of 23 patients followed for a mean of 22 years after isolated ankle arthrodesis for post-traumatic arthritis. Using bilateral radiographs (Kellgren and Moore grading), clinical exam, and validated questionnaires, the study asks whether ankle fusion accelerates osteoarthritis in adjacent lower-extremity joints. This is the longest follow-up series of ankle arthrodesis reported at the time of publication.
Ankle arthrodesis has long been considered the gold standard for end-stage ankle arthritis, but prior series had follow-up of only 8–12 years — too short to capture the full cost of the procedure.
This paper establishes the long-term trade-off: ankle fusion reliably eliminates ankle pain but predictably transfers stress to six adjacent foot joints, causing accelerated degeneration over the following two decades.
When counseling a patient before ankle arthrodesis, tell them directly: the ankle will feel better, but expect progressive hindfoot and midfoot arthritis, likely limiting walking distance and requiring walking aids in later years. The knee will be spared.
The finding that talonavicular arthritis drives functional limitation more than any other joint (r=0.79) has a practical implication. Monitor the talonavicular joint at long-term follow-up visits, as its status predicts who will become most disabled.
This data is part of the rationale for considering total ankle replacement in younger, active patients where preserving adjacent joint motion may delay or reduce this degenerative cascade.