*Article* **Preservation of the Subtalar Joint Determines Outcomes in a 10-Year Evaluation of Ankle Arthrodesis**

**Rebecca Sell 1, Magalie Meinert 2, Eva Herrmann 3, Yves Gramlich 2, Alexander Klug 2, Oliver Neun 1, Reinhard Hoffmann <sup>2</sup> and Sebastian Fischer 1,\***


**Abstract:** Posttraumatic osteoarthritis may lead to surgical fusion of the ankle joint if non-surgical therapy fails. The indication for a fusion of the joint is based on the pain and disability of the patient, radiographic imaging, and surgeon experience, with no strict guidelines. We aimed to compare outcomes after tibiotalocalcaneal arthrodesis (TTCA) and tibiotalar arthrodesis (TTA) to highlight the functional importance of the subtalar joint. In total, 432 patients with ankle arthrodesis were retrospectively enrolled. Group A (*n* = 216) underwent TTCA; group B (*n* = 216) underwent TTA. Demographics, Olerud & Molander Ankle Score (OMAS), Foot Function Index (FFI-D), and Short Form-12 Questionnaire (SF-12) were recorded at a mean follow-up of 6.2 years. The mean OMAS was 50.7; the mean FFI-D was 68.9; the mean SF-12 physical component summary was 39.1. These scores differed significantly between the groups (*p* < 0.001). The overall revision rate was 18%, primarily for revision of non-union and infection (*p* < 0.001). Approximately 16% of group A and 26% of group B were able to return to previous work (*p* < 0.001). Based on significantly worse clinical scores of TTCA compared to TTA and the prolonged downtime and permanent incapacity, the indication for a generous subtalar joint arthrodesis with planned ankle arthrodesis should always be critically examined.

**Keywords:** ankle arthrodesis; tibiotalocalcaneal arthrodesis; subtalar arthrodesis; gait pattern; posttraumatic osteoarthritis
