Outcomes Following Midfoot Arthrodesis for Primary Arthritis

Background: Primary midfoot arthritis is a disabling painful condition of the foot. The aim of the study was to assess the functional outcomes following midfoot arthrodesis for primary midfoot arthritis. Materials and Methods: Between 2000 and 2006, 95 patients (104 feet) underwent midfoot arthrodesis for primary midfoot arthritis. Midfoot collapse, if present, was corrected at the time of arthrodesis. Mean age at surgery was 62 years. Gastrocnemius contracture was seen in 81 (78%) feet and was treated with a recession. Radiographs were reviewed for correction of deformity. Complications and reoperations were noted. Outcome evaluation included pain, American Orthopaedic Foot Ankle Society (AOFAS) midfoot score and patient satisfaction. Outcomes were available in 68 patients (74 feet) with mean followup of 56 (range, 24 to 102) months. Results: We achieved union in 96 out of 104 feet (92 %). There was one delayed union and eight nonunions. Major complications (4/104, 4%) included three deep infections and one chronic regional pain syndrome. Reoperations were required in 11 feet in addition to 26 symptomatic hardware removals. Radiographs showed a significant improvement in the tab-first metatarsal angle and medial cuneiform height. Pain improved from preoperative mean of 7 +/- 2 to postoperative mean of 2 +/- 2. AOFAS score improved from preoperative mean of 32 (range, 25 to 43) to postoperative mean of 79 (range, 65 to 90). Ninety percent of patients were satisfied with the final result. Conclusion: Primary or degenerative arthritis of the midfoot with refractory symptoms was treated with midfoot arthrodesis with good results and a low incidence of nonunion.