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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109

Volume 10, Issue 3, April 2014 pp 412-415

Research Article

Association between Radiological and Clinical Outcomes in Osteoarthritis of the Tibiotalar and Midfoot joints after Triple Arthrodesis in Talipes Equinovarus Deformity


Cherian Jacob1, Anoop R. L.2, Nithin Thomas Philip3, Virat Swaroop Srivastava4, Samson Nessiah5

1,5Professor, 3Resident, 4Resident, Department of Orthopaedics}{2Assistant Professor, Department of Psychiatry}

Dr. S.M.C.S.I. Medical College and Hospital, Karakonam, Trivandrum 695011, Kerala, INDIA.

Academic Editor : Dr. Aher K.R.



 Triple arthrodesis(TRA) is a reliable  method  of correcting severely deformed, painful and paralytic feet, giving stability, reducing symptoms and improving function in  complex situations in which very  few, other suitable alternatives exist. It provides a painless, stable, plantigrade foot .However there have been reports regarding late onset osteoarthritis(OA) of the tibiotalar and midfoot joints going upto77% in some series. This has resulted in reluctance to do the procedure on the part of many surgeons.Consequently many patients are , probably unnecessarily,forced to live with a deformity and it’s disability .Materials and Methods: In this prospective cohort study,done on all consecutive patients treated with triple arthrodesis between 2005 and 2013, we determined the incidence of radiological osteoarthritis changes at the ankle and midfoot graded according to the van Dijk grading , and clinical symptoms and signs of pain, tenderness, stiffness of the ankle joints and attempted to study the correlatory significance between the two. Changes in the contralateral feet in unilateral cases were also recorded pre-op and postoperatively.We also attempted to gauge patient satisfaction with the procedure using a5 point visual analogue scale.Results:The results show a high incidence of radiological OA ,upto50 %, as graded by Van Djik with majority in grade1 and a couple in grade2.However clinical findings of pain etc were found only in 16% of those with radiological OA and 9% of all feet.Progression of radiological OA changes was also seen in the normal feet in unilateral cases raising the question as to whether the OA changes are really a result of the surgical procedure. Despite the patients having symptomatic OA, they were satisfied with the outcome (95%) and would readily undergo the procedure again and recommend the procedure to other patients(95%).Conclusion:We conclude that there is low correlation between radiological OA and clinical symptoms and signs of the same.The fear of OA should not be a deterrent to performing the procedure when indicated.