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Previous subtalar fusion increases nonunion rate for primary open ankle arthrodesis Ornusa Chalayon, Bibo Wang, Brad Blankenhorn, J. Benjamin Jackson III, Florian Nickisch, Timothy Beals, Charles L Saltzman My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation. Introduction • Arthrodesis of the ankle is the mainstay of treatment for advanced arthritis. • Both the patient (host) and surgical (treatment) factors determine the success of the fusion. • Study objective: to identify any factors that affect the surgical outcome in straightforward, “noncomplicated” ankle fusions Materials & Methods • Retrospective chart review study • Inclusion criteria : Patients underwent primary open ankle arthrodesis at the University of Utah’s facilities over an eleven-year period (March 2002 to January 2013, who had a minimum of 6 months follow-up X-rays • Exclusion criteria : - neuropathic arthropathy or insensate limb - failed total ankle replacement - simultaneous arthrodesis of the subtalar joint - fusions performed within 1 year of ankle injury to salvage failed fixation and painful function due to 1) open fractures, 2) segmental bone loss >1 cm, 3) infection , 4) talar body fractures Materials & Methods • Primary outcome : radiographic union by 6 months after surgery, as defined by the plain radiographs • Secondary outcome : postoperative complications • Potential predictor variables : age, gender, weight and height, underlying medical condition(s), history of smoking and alcohol consumption or illicit drug use, etiology of arthritis, preoperative ankle alignment, history of a prior subtalar fusion and the surgical technique used for ankle arthrodesis • Statistical analysis : multivariable mixed effect Poisson regression Results • 528 ankle fusion surgeries were performed on 440 patients at our institution during the study period • 215 ankle fusion surgeries in 209 patients met inclusion/exclusion eligibility criteria for noncomplicated open ankle fusions • 91% overall union rate Univariate analysis identified elicit drug used and previous subtalar fusion as potential predictor factors of ankle fusion nonunion. After using a multivariable mixed effect Poisson regression model to test these two factors, previous subtalar fusion remained a significant risk factor for nonunion. Risk factors Univariate analysis Multivariate analysis Risk ratio P-value Risk ratio P-value Elicit drug use 5.31 0.06 3.28 0.12 Previous subtalar fusion 4.18 0.03 3.06 0.048 Complications • Diabetes was not a significant risk factor of either deep or superficial infection, with a relative risk of 1.62 (p = 0.54) and 1.12 (p = 0.84), respectively. • For presumed infection treated surgically, smoking had a relative risk of 11.36, with a marginal significance of p=0.08. • Smoking also elevated the risk of ultrasound proven venous thromboembolism: 5 times when compared to the controls (p = 0.04). Discussion/Conclusion • Ankle arthrodesis failed in 9% of noncomplicated ankles with arthritis • Patients who had an ankle fusion done after the arthrodesis of subtalar joint had significantly higher rate of non-union • Smoking is associated with increased risk of complications.