Early and Mid-term Effects of Ankle and Hindfoot Arthrodesis on Quality of Life

Background: Hindfoot fusion is commonly performed to relieve pain in patients with end-stage ankle and hindfoot arthritis. However, its impact on specific aspects of health-related quality of life (HrQoL) and the trajectory of improvement is not well established. This study aimed to evaluate the effect of hindfoot fusion on HrQoL at both short- and mid-term follow-up. Methods: A retrospective review was conducted on a prospective database of patients who underwent hindfoot fusion for severe pain, including ankle, subtalar, and tibiotalocalcaneal arthrodeses. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and the 36-Item Short Form Health Survey (SF-36) scores for HrQoL: Physical Functioning (SFPF), Role Physical (SFRP), Bodily Pain (SFBP), General Health (SFGH), Vitality (SFVI), Social Functioning (SFSF), Role Emotional (SFRE), and Mental Health (SFMH). Patient satisfaction was assessed using a Likert scale. Scores were recorded preoperatively, 6 months postoperatively, and 2 years postoperatively. Although optimal deformity correction was desired, alleviation of pain was the main goal and deformity angles were not analysed in this study. Results: At 6 months, ankle fusion patients reported significant improvements in SFPF (+21.00, P < .001), SFRP (+23.33, P < .020), SFBP (+30.73, P < .001) and SFSF (+20.38, P = .022) whereas tibiotalocalcaneal patients reported improvements from baseline SFPF (+28.18, P < .001), SFRP (+43.18, P < .001), SFBP (+42.32, P < .001), and SFSF (+35.25, P < .001). Subtalar fusion patients recorded improvements in SFBP (+17.09, P = .014). All 3 fusion groups demonstrated sustained improvements in HrQoL at 2 years postoperatively. VAS scores reduced by 3.8-5.9 points across all fusion groups. Patient satisfaction was high at both 6 months and 2 years postoperatively. Conclusion: Hindfoot fusion was associated with significant gains in functional and pain-specific patient-reported outcomes. Improvements were mainly observed within the first 6 months for ankle and tibiotalocalcaneal fusion, with subtalar fusion demonstrating a slower but comparable trajectory of recovery. High patient satisfaction was reported across all groups at 2 years. Level of Evidence: Level III, retrospective cohort study.