Ankle arthrodesis by compression screws in rheumatoid arthritis: primary nonunion in 9/35 patients.

Introduction: Today, percutaneous or open arthrodesis of the ankle, using one or several screws for fixation, is a common method for treatment of the rheumatic ankle. However, there is very little information in the literature on the reliability of the method.

Methods: We performed a retrospective radiographic and clinical study on 35 ankles of 35 patients. Function was evaluated using the Mazur and AOFAS scores. For evaluation of activity of the rheumatic disease, we used the HAQ score.

Results: 31 ankles had healed--26 at the first attempt and 5 after repeat arthrodesis. There was no difference between 13 cases operated on percutaneously and 22 cases operated on with open technique with respect to radiographic healing. Mean AOFAS total score was 56 of possible 86 points. The AOFAS total score correlated with the severity of the rheumatic disease. 20 patients were satisfied with the result, 12 were somewhat satisfied and 3 patients were dissatisfied although the ankle in 2 of these 3 patients had fused.

Interpretation: The use of compression screws for fusion of the rheumatic ankle does not appear to give acceptable results regarding healing and function.