Outcomes of Bilateral vs Unilateral Ankle Arthrodesis

Background: While ankle arthrodesis is a common treatment for severe ankle osteoarthritis, performing bilateral ankle arthrodesis is controversial because of associated problems, such as severe gait abnormality and bilateral loss of talocrural joint motion. Furthermore, few reports exist regarding the detailed outcomes of bilateral ankle arthrodesis. Therefore, we aimed to compare the outcomes of bilateral ankle arthrodesis with those of unilateral ankle arthrodesis, using both subjective and objective assessments. Methods: The data from 20 patients (10 each in the bilateral and unilateral groups), who underwent arthrodesis between 2005 and 2015, were retrospectively reviewed. The minimum follow-up duration was 2 years. Radiographic outcomes were assessed using radiographs and computed tomography. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) scale and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results: With the numbers available, no significant group differences were observed for any of the patient characteristics or postoperative range of motion. Mean JSSF scale scores significantly improved in both groups (P <.001); however, scores on the SAFE-Q subscale for “social functioning” were significantly lower in the bilateral group compared to the unilateral group (P =.049). Conclusions: Within the limitations of the current study design, bilateral ankle arthrodesis did not appear to be inferior to unilateral ankle arthrodesis, with the possible exception of social functioning ability. Thus, bilateral ankle arthrodesis can be considered a viable treatment option. Level of Evidence: Level III, retrospective cohort study.