Patient satisfaction and function after bilateral ankle arthrodeses Philip Vaughan FRCS (Tr & Orth)*, David Gordon MD, FRCS (Tr & Orth) 1 , Andy Goldberg MD, FRCS (Tr & Orth) 1 , Nick Cullen FRCS BSc (Hons), (Tr & Orth) 1 , Dishan Singh FRCS (Orth) 1 Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK 1. Introduction Symptomatic ankle osteoarthritis (OA) is a condition that causes major disability, has a similar impact on quality of life to that of end stage cardiac failure [1] and end stage hip OA [2]. The current demand incidence of ankle OA has been estimated to be 47.7 per 100,000 in the United Kingdom [3]. The majority of ankle OA is treated non-operatively with activity modification, splints, analgesia and physiotherapy; however in the UK, up to 3000 patients per year undergo surgery (when the condition is known as end stage), requiring either ankle arthrodesis (AA) or total ankle replacement (TAR). The goals of surgical management of end stage ankle OA are to eliminate pain and deformity, allow mobilisation and return of function. Both AA and TAR have been shown to significantly improve overall function [4] and the benefit of unilateral AA in particular can be seen to persist into the medium [5] and up to 20 years post-operatively [6]. However, whilst there is a perceived benefit for TAR [7,8] particularly in those with bilateral ankle OA [7], the evidence supporting the use of TAR over AA is weak and the optimum way to manage those with bilateral ankle OA remains unclear. The purpose of this study is to report the midterm outcomes of patients undergoing bilateral staged AA in terms of their satisfaction and their functional outcome. 2. Methods Patient demographics, co-morbidities and peri-operative details and technique were recorded and are summarised in Table 1. We reviewed the case notes of all patients who had undergone bilateral AA at our institution between January 2004 and December 2013. Only those who had undergone isolated bilateral ankle fusion for painful, bilateral ankle OA refractory to non-operative management were included in the study. Patients with an Foot and Ankle Surgery 21 (2015) 160–163 A R T I C L E I N F O Article history: Received 22 July 2014 Received in revised form 21 October 2014 Accepted 3 November 2014 Keywords: Arthritis Bone Internal fixation Outcome Talus Tibia A B S T R A C T Background: The optimum way to manage patients with bilateral ankle arthritis (AA) is unclear. Methods: This review was performed to report the midterm satisfaction and functional outcome of a series of patients who have undergone bilateral staged ankle arthrodesis. Results: Eight patients, median age 68.5 yrs (range 59–80) were followed-up for a median of 58.5 months (range 24–100). All fusions united in a median time of 12.8 weeks (range 10–19) Their median AOFAS hindfoot score was 79.5 (range 71–90). Six patients (75%) were very satisfied, one was satisfied, and the other neither satisfied nor dissatisfied. Two patients developed symptomatic subtalar arthritis requiring subtalar fusion. Conclusions: This is the first study to report the outcome of bilateral AA independent to that of unilateral AA. Bilateral AA appears to give patients a good functional result with high patient reported satisfaction into the medium term. ß 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. Abbreviations: BP, hypertension; D, dancing; DM, Diabetes Mellitus type 2; DJ, desk job; FWB, full weight bearing; G, golf; MJ, manual job; M, manual activity; NDA, normal daily activity; NWB, non-weight bearing; PTC, partially threaded cancellous screws; Px, patient number; PWB, partially weight bearing; R, retired; S, satisfied; S/ D, neither satisfied or dissatisfied; ST, symptomatic subtalar joint OA requiring fusion; TB, non-active tuberculosis; VS, very satisfied; WLD, walking long distances >1 mile. * Corresponding author at: Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK Tel.: +44 07971 660140. E-mail address: drphilipvaughan@yahoo.com (P. Vaughan). 1 Tel.: +44 0208 909 5842; fax: +44 0208 8909 5636/954 5407. Contents lists available at ScienceDirect Foot and Ankle Surgery jou r nal h o mep age: w ww.els evier .co m/lo c ate/fas http://dx.doi.org/10.1016/j.fas.2014.11.001 1268-7731/ß 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.