Factors Influencing Functional Outcomes of Subtalar Fusion for Posttraumatic Arthritis After Calcaneal Fracture

Foot Ankle Int. 2018 Sep;39(9):1062-1069. doi: 10.1177/1071100718777492. Epub 2018 Jun 4.


Background: Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis. This study aimed to identify factors associated with functional outcomes and quality of life after subtalar fusion for posttraumatic subtalar arthritis after calcaneal fracture.

Methods: This is a retrospective study with follow-up by questionnaire in two level 1 trauma centers. Patients who underwent subtalar arthrodesis for posttraumatic arthritis after a calcaneal fracture between 2001 and 2016 were identified and contacted for completion of a survey consisting of the Foot and Ankle Ability Measure (FAAM), Maryland Foot Score (MFS), Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire, EuroQol 5-dimensional (EQ-5D) questionnaire, and EuroQol visual analog scale (EQ-VAS). Exclusion criteria were initial subtalar arthrodesis at an outside facility, primary arthrodesis for fracture, initial arthrodesis earlier than 2001, amputation of the fused foot or leg, younger than 18 years at time of fusion, and inability to communicate in English. A total of 159 patients met our inclusion criteria. Eighty-four patients completed the questionnaires, resulting in a response rate of 59%.

Results: Median FAAM score was 79 (interquartile range [IQR], 48-90), median MFS was 74 (IQR, 56-86), and median PROMIS PF was 45 (IQR, 38-51). Quality of life was significantly lower when compared to a reference population ( P = .001). Smoking was independently associated with worse outcomes. Complications after fusion (such as nonunion, implant failure, and infectious complications), high-energy trauma, and ipsilateral injury were also predictors for poorer outcomes.

Conclusion: Acceptable functional outcomes and quality of life were observed after subtalar fusion. Smoking, complications after subtalar fusion, high-energy trauma, and presence of ipsilateral injuries were independently associated with worse functionality and quality of life.

Level of evidence: Prognostic level III, comparative series.

Keywords: calcaneal fracture; functional outcome; outcome studies; posttraumatic arthritis; quality of life; subtalar fusion; trauma.

MeSH terms

  • Adult
  • Arthritis / etiology
  • Arthritis / surgery*
  • Arthrodesis / methods*
  • Calcaneus / injuries*
  • Calcaneus / surgery
  • Female
  • Follow-Up Studies
  • Foot Injuries / complications
  • Fractures, Bone / complications*
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Postoperative Complications
  • Quality of Life*
  • Retrospective Studies
  • Smoking / adverse effects
  • Subtalar Joint / surgery*
  • Surveys and Questionnaires
  • Trauma Centers
  • Treatment Outcome