A Guide To The Triple Arthrodesis For Hindfoot Deformities

Kevin Dux, DPM, Sarah Edgar, DPM, and Peter Blume, DPM, FACFAS

What Long-Term Follow-Up Reveals On Patient Satisfaction

Since the development of the procedure in 1921, there has been ample time to perform longitudinal studies to determine outcomes and patient satisfaction with the triple arthrodesis. Despite the amount of restriction and long postoperative course, a triple arthrodesis has a very high patient satisfaction rate. Multiple studies have been published on the results of triple arthrodesis from five years to long-term follow up of up to 44 years with satisfaction rates as high as 95 percent (see the table “A Closer Look At Long-Term Studies” at left).2,5,6

   There are some key points that can increase patient satisfaction. The first is expectations management. The triple arthrodesis was, is and always will be a procedure for reconstruction of end-stage disease. By explaining that the goals are to decrease pain and improve function, not to create a disease-free foot, patients are unlikely to be surprised by some of the inevitable sequelae of the procedure. While technically demanding and not without flaws, the triple arthrodesis is still the cornerstone for reconstruction of severe hindfoot deformities.

In Conclusion

The human foot is an anatomically and biomechanically complex structure that must endure tremendous stresses, even in normal gait.

   Accordingly, reconstruction of hindfoot deformities is a demanding task that requires both diagnostic and surgical acumen. The triple arthrodesis has proved to be a reliable, powerful and reproducible procedure for the treatment of a wide variety of common pathologies in the podiatric practice. The procedure has many different applications and, through various modifications over the years, has continued to produce very high satisfaction rates for patients with end-stage disease.

   Dr. Dux is a third-year resident at Yale-New Haven Hospital in New Haven, Conn.

   Dr. Edgar is a second-year resident at Yale-New Haven Hospital.

   Dr. Blume is an Assistant Clinical Professor of Surgery in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine. He is the Director of Limb Preservation at the Yale New Haven Hospital. Dr. Blume is a Fellow of the American College of Foot and Ankle Surgeons.

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