# LOTIC: Long-Term Outcomes After Triple Arthrodesis in Children—A Retrospective Case Series

## TL;DR

A study finds that many children who had a foot surgery called triple arthrodesis still experience pain and limited mobility into adulthood.

## Contribution

This is one of the few studies to evaluate long-term patient-reported outcomes of pediatric triple arthrodesis using standardized tools.

## Key findings

- Over half of patients reported ongoing pain in adult life after pediatric triple arthrodesis.
- Functional outcomes and satisfaction were variable, with some patients showing no improvement in mobility.
- Psychosocial impacts and lack of functional improvement were common according to patient and carer reports.

## Abstract

What are the main findings?
According to patient- and carer-reported outcome measures, over half of patients in this case series after paediatric triple arthrodesis still have pain in adult life.Satisfaction after surgery and improvement in functional outcomes in this complex patient cohort are also variable in adult life, with concerning rates of pain, lack of functional improvement and ongoing psychosocial impact, according to patients and their carers.

According to patient- and carer-reported outcome measures, over half of patients in this case series after paediatric triple arthrodesis still have pain in adult life.

Satisfaction after surgery and improvement in functional outcomes in this complex patient cohort are also variable in adult life, with concerning rates of pain, lack of functional improvement and ongoing psychosocial impact, according to patients and their carers.

What are the implications of the main findings?
There was a significant risk in this cohort of patients having problems in adult life after having this surgery in childhood.Careful patient selection and pre-operative counselling, more modern pre-operative planning and surgical techniques, selective soft tissue balancing and longer-term follow-up may help future outcomes.

There was a significant risk in this cohort of patients having problems in adult life after having this surgery in childhood.

Careful patient selection and pre-operative counselling, more modern pre-operative planning and surgical techniques, selective soft tissue balancing and longer-term follow-up may help future outcomes.

Background/Objectives: Triple arthrodesis (TA) involves fusion of subtalar, talonavicular and calcaneocuboid joints. In the paediatric population, this procedure is used to correct foot deformities, augment stability and decrease pain, often in neuromuscular conditions. There is limited research into long-term outcomes of paediatric TA in regards to patient quality of life (QOL). This study aims to retrospectively evaluate the long-term patient-reported outcomes of the paediatric TA at a single centre. Methods: All paediatric patients who underwent TA at the Women’s and Children’s Hospital between 1998 and 2012 were identified from operative records and the patient and/or their carer were given the opportunity to be interviewed. Patient-reported outcomes were measured over the phone using the Foot and Ankle Ability Measure (FAAM) and Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) tools. Results: Eighteen patients were included in the study, with a total of 23 feet, with five patients having bilateral surgery in the one sitting. Follow-up was at a mean time of 17 years post-surgery, with a mode of 20 years. There were recurring themes of continued pain plus impaired function and mobility, especially in children who could not walk prior to surgery. Derived from the FAAM, the average Activities of Daily Living Scale was 39.81%, with four patients at 0%. The MOXFQ outcomes for walking, pain and social interaction domains were converted from the Likert scale into an average total score of 34.99/64. Over half of the patients continued to have pain after the surgery in adult life. Conclusions: This study highlights variable results post-paediatric triple arthrodesis, with concerning rates of limited improvement in functional outcomes, ongoing pain and negative psychosocial impact in adulthood, as reported by the patient or their carer.