Comparative Results of Triple Arthrodesis for the Management of Stage III Posterior Tibial Tendon Dysfunction between Rheumatoid and Non-Rheumatoid Patients

Abstract

Abstract Objective Although the recommended treatment for stage III posterior tibial tendon dysfunction (PTTD) is triple joint complex fusion, the literature is limited on this topic. No study has specifically investigated the influence of rheumatoid arthritis (RA) on the outcomes of triple arthrodesis. This study aimed (1) to report mid-to-long-term results of triple arthrodesis for stage III PTTD and (2) to investigate the difference in the results of triple arthrodesis between rheumatoid and nonrheumatoid patients. Methods Thirty feet of 25 patients (16 females, 9 males; mean age 53, (39-71)) with stage III PTTD who were treated by triple arthrodesis were retrospectively analyzed. The mean follow-up was 82 (28 – 144) months. Patients were divided into two groups based on etiology: group ID (idiopathic PTTD) and group RA (PTTD secondary to RA). All clinical and radiographic outcomes were compared. The mean American Orthopedic Foot and Ankle Society (AOFAS) score was measured preoperatively and at the final follow-up. The 36-Item Short Form Survey (SF-36) and visual analog scale (VAS) were measured at the final follow-up. Results The mean AOFAS score improved from 57±6.81 (46–68) and 49±14.66 (18–79) preoperatively to 82±15.57 (44–94) and 77±14.46 (48–94) in group ID and group RA, respectively, with no significant difference between thepre- and postoperative values between the groups (p <.001). The mean VAS score at rest was 0.45±0.68 (0–2) in group ID and 1±1.08 (0–3) in group RA (p =.23). There was no significant difference in any SF-36 domain(p >.05) except for physical health, which was lower in the RA group (p =.002). Conclusion Although rheumatoid patients present with radiographically more severe flatfoot deformity, triple arthrodesis can provide similar satisfactory clinical and radiological outcomes with a low complication rate for stage III PTTD in rheumatoid patients as much as nonrheumatoid patients in long-term follow-up. Level of Evidence: Retrospective cohort study, Level 3 Evidence