-Original-

Long-term Results of Ankle Arthrodesis Using an Intramedullary Nail with Fins in Patients with Rheumatoid Arthritis Hindfoot Deformity

Kenji Takenouchi^1,2, Minoru Morishita^1,2, Kimihisa Saitoh³, Kouichi Wauke³, Hiroshi Takahashi³ and Masakazu Nagashima^1-3

¹Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School
²Department of Joint Disease and Rheumatism, Nippon Medical School Hospital
³Department of Rheumatology, Tokyo Metropolitan Bokutoh Hospital

We report herein the results of a retrospective study of 30 ankle arthrodesis procedures performed in 27 patients with rheumatoid arthritis from 1994 through 2001 using a novel design of intramedullary nail with fins. The surgical treatment, post-operative management and clinical evaluation are described. The clinical evaluation, at an average follow-up period of more than 10 years, was based on foot disease scores from the Japanese Orthopaedic Association and scores obtained preoperatively, postoperatively, and during follow-ups 1 (November 2001) and 2 (November 2007) were compared. These variables showed significant improvement between before surgery and at follow-up evaluations. Non-union was not observed and no marked changes of the Chopart joint were seen between before surgery and at follow-up evaluations. Delayed wound healing was seen in 9 of 30 joints. However, infection neuropathy or other complications were not found. We conclude that arthrodesis using an intramedullary nail with fins is an effective treatment for severe hindfoot deformities in patients with rheumatoid arthritis because no cases of non-union were observed and because clinical results over the mean 10-year follow-up period were good or satisfactory.

J Nippon Med Sch 2009; 76: 240-246

Keywords
rheumatoid arthritis, hind foot deformity, ankle arthrodesis, long-term results, intramedullary nail with fins

Correspondence to
Masakazu Nagashima, MD, Department of Rheumatology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotohbashi Sumida-ku, Tokyo 130-8576, Japan
m_nagashima@bokutoh-hp.metro.tokyo.jp

Received, February 23, 2009
Accepted, June 16, 2009