Results of triple arthrodesis

NewsBot · Nov 2, 2019

Intermediate to Long Term Clinical and Radiographic Outcomes of Triple Arthrodesis: A 422 Case Retrospective Review
Jesse King, BSc, Karl Henrikson, MD, Thomas Harper, ...
Foot & Ankle Orthopaedics October 28, 2019

Introduction/Purpose:
Triple arthrodesis is a commonly performed surgical treatment for hindfoot arthritis and deformity. No study has clearly delineated correlates of both clinical and radiographic outcomes in a sample size this large. The purpose of this study is to explore predictive and demographic outcome measures with long-term followup after triple arthrodesis.

Methods:
With IRB approval, an institutional radiology database was queried for patients undergoing triple arthrodesis between 2004 and 2016, by a single surgeon at a single institution. A total of 465 cases were identified. Pre- and post-operative clinical and radiographic data was collected retrospectively. Demographic and predictive data included: age, Body Mass Index (BMI), American Society of Anesthesiologists Score (ASA), Charleston Comorbidity Index (CCI), diabetic status, osteoporosis, hypothyroidism, and neuromuscular disease status. Clinical outcomes including infection rate, reoperation rate and clinical nonunion were recorded.

Unintended return to the operating room defined clinical failure. Radiographic data including non-union rate, pre- and post- operative ankle degenerative joint disease was also recorded. Statistical analysis was then performed to evaluate the relationship between predictive measures and various outcomes including reoperation, infection, and non-union rates. 23 cases were lost to follow-up.

Results:
A total of 442 feet (397 patients) were analyzed. The average age was 54 years (14 to 85) with the majority of cases being female (60%). Average follow up was 593 days (40 to 4079). Overall failure rate was 13.7% with clinical nonunion rate of 4.5%. Infection rate was 5.9%. Mortality rate was 0% at 2 years post-operatively. Predictors of failure included: increased BMI, elevated ASA, history of diabetes, underlying neuromuscular disorder (Figure 1). We found no significant difference between pre and post-operative degenerative joint disease rates in the midfoot (9.4%, 12.5%) and ankle (11.7%,13.7%), respectively.

Conclusion:
Triple arthrodesis is a highly effective procedure for treating hindfoot arthritis. Certain predictive measures including BMI, ASA score, diabetic status and underlying neuromuscular disorders significantly correlate with radiographic union. Additionally, diabetic status significantly correlates with infection status postoperatively. An understanding of these predictive measures may help surgeons in their preoperative planning to improve their clinical and radiographic success rates.
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NewsBot · May 4, 2020

Range of motion of foot joints following total ankle replacement and subtalar fusion
Federico G.Usuelli et al
Foot and Ankle Surgery

Highlights
•Total ankle replacement and subtalar fusion is a viable procedure
•By excluding subtalar motion, the replaced ankle joint motion can be isolated
•In these patients gait analysis can assess the isolated ankle motion
•In these patients kinematics is improved even if it is not restored to normal value
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Background
In severe cases of ankle and subtalar arthritis, arthrodesis of the subtalar joint is performed in combination with ankle arthroplasty. In these special cases gait analysis reveals real motion at the replaced tibiotalar joint.

Methods
23 patients affected by ankle and subtalar arthritis, treated either with a 3-component or a 2-component prosthesis in combination with subtalar arthrodesis, were clinically evaluated preoperatively and at a minimum of 1-year follow-up. Gait analysis was performed postoperatively using a multi-segment foot protocol. Foot kinematics were compared to corresponding data from a healthy control group.

Results
Clinical scores significantly improved from preoperative to follow-up. The clinically measured passive ankle dorsiflexion/plantarflexion significantly improved at the follow-up. Patients’ normalized walking speed and stride length were significantly lower than those in control. With exception of the ankle frontal-plane motion, sagittal-plane mobility of foot joints was about 50% than that in healthy joints.

Conclusions
Improvement in clinical scores was found for both prostheses. Normal spatio-temporal parameters were not restored. In these patients, fusion of the subtalar joint appeared to be compensated by larger frontal-plane motion at the tibiotalar joint.
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NewsBot · Dec 27, 2020

Bilateral gait asymmetry associated with tibiotalocalcaneal arthrodesis versus ankle arthrodesis
SwatiChopraabXavierCrevoisiera
Foot and Ankle Surgery18 December 2020

Highlights
•Tibiotlocalcaneal arthrodesis (TTCA) patients reported gait alteration.
•Gait asymmetry following Ankle arthrodesis is larger than TTCA.
•Effect of ankle surgeries can be seen on gait mechanics at forefoot and toes.
•Altered push-off mechanics during pre-swing is found following ankle fusion surgeries.
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Background
Gait asymmetries have been reported following ankle arthrodesis. However, similar reports do not exist for tibiotalocalaneal arthrodesis (TTCA), which involves further articular fusion. This study aimed to assess the extent of gait asymmetry following TTCA when compared to ankle arthrodesis.

Method
Gait assessment was performed on 36 participants, including 12 ankle arthrodesis, 12 TTCA and 12 controls – using 3-D inertial sensors and pressure insoles. 48 gait parameters were monitored on both operated and non-operated sides. Questionnaires including AOFAS, FAAM, EQ-5D were used to assess both operative groups, comparatively.

Results
Both operative groups reported significantly smaller stride, slower walking speed, altered stance phase with longer loading and shorter push-off compared to controls. Joint range of motion was significantly reduced on the operated side of both operative groups at hindfoot, forefoot and toe intersegments. However, the ankle arthrodesis group reported a significantly higher alteration compared to controls in maximum contact force and pressure distribution. Furthermore, bilateral comparison showed extended gait asymmetry in the ankle arthrodesis group with 29 out of 48 parameters being significantly different between the two sides, whereas only 16 out of 48 gait parameters showed bilateral difference in the TTCA group.

Conclusion
Both ankle salvage operations led to significant gait alteration and bilateral asymmetry. However, extended joint restriction in TTCA does not seem to worsen the gait outcomes. Further investigation is needed to understand the long-term impact of altered gait, on neighboring joints, following TTCA.
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NewsBot · Mar 2, 2021

Risk Factors for Nonunion Following Tibiotalocalcaneal Arthrodesis: A Systematic Review and Meta-Analysis
SumitPatelMS et al
Foot and Ankle Surgery; 1 March 2021

Highlights
•First meta-analysis to identify potential risk factors for nonunion following tibiotalocalcaneal arthrodesis.
•Performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and methodology registered with the International prospective register of systematic reviews (PROSPERO).
•Prior neuropathic conditions have strong evidence for failure to achieve union.
•Studies in our review suggest that diabetes mellitus can lead to failure of fusion.
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Background
The goal of this study is to review the literature to identify risk factors for nonunion after tibiotalocalcaneal arthrodesis (TTCA) and stratify them based on strength of evidence.

Methods
Five databases were searched from inception to May 17th, 2020. Abstracts and full-text articles were screened for those that included risk factors predictive of nonunion following TTCA.

Results
Eight studies involving 624 patients were included and 33 potential risk factors for nonunion were identified. Strong evidence supported prior peripheral neuropathic conditions as risk factors for nonunion following surgery (OR: 2.86, 95% CI: 1.56 - 5.23).

Conclusion
TTCA is an effective salvage procedure but is associated with high nonunion rates. The results of our meta-analysis suggest that prior peripheral neuropathic conditions have strong evidence for failure to achieve union. Surgeons should be cognizant of these risks when performing TTCA and carefully monitor patients with the aforementioned comorbidity to achieve successful results.
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NewsBot · Aug 5, 2021

Comparison of 4 Different Fixation Strategies for Midfoot Arthrodesis: A Retrospective Comparative Study
Wonyong Lee et al
Foot Ankle Spec. 2021 Aug 2

Background: Midfoot arthrodesis is a common procedure performed both for arthritis and correction of deformity. The optimal fixation for midfoot arthrodesis has not been established, though numerous studies have been investigating the fixation techniques of midfoot arthrodesis. The purpose of this study was to compare the union rate of midfoot arthrodesis using 4 different fixation strategies and investigate risk factors of nonunion following midfoot arthrodesis.

Methods: A retrospective chart review was performed for patients who underwent midfoot joint arthrodesis between January 2014 and May 2019. The rates of nonunion and postoperative complication were compared among 4 different fixation constructs: staple fixation, compression plate fixation, compression plate with lag screw fixation, and compression screw fixation. Predictors of nonunion following midfoot arthrodesis were investigated through a multivariable logistic regression analysis. A total of 95 patients (99 feet), including 240 midfoot joints were included in this study. The mean follow-up period was 78.4 weeks.

Results: Overall, bony union was achieved in 86 out of 99 (86.9%) patients, which included 218 out of 240 (90.8%) midfoot joints. A significant difference in the nonunion rate according to the type of fixation construct was found (P = .011); the compression screw alone fixation construct was noted to have a significantly higher nonunion rate than other fixation constructs. Diabetes mellitus (odds ratio [OR] = 0.179 [95% CI: 0.059, 0.542]), the type of fixation construct (compression screw alone; OR =1.789 [95% CI: 1.071, 2.978]), lack of adjuvant bone graft (OR = 2.803 [95% CI: 1.081, 7.268], and postoperative nonanatomical alignment (OR = 3.937 [95% CI: 1.278, 12.126]) were identified as independent predictors of nonunion following midfoot arthrodesis.

Conclusion: The rate of nonunion following midfoot arthrodesis among 4 different commonly used fixation constructs was compared in this study. Risk factors of nonunion were investigated revealing that diabetes mellitus, compression screw fixation alone, lack of adjuvant bone graft, and postoperative nonanatomical alignment are independent predictors of nonunion following midfoot arthrodesis.
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NewsBot · May 12, 2022

An Umbrella Systematic Review and Meta-Analysis of Systematic Reviews on the Topic of Foot and Ankle Arthrodesis Nonunion Rates
Tyler L. Coye, DPM et al
May 04, 2022

The purpose of this systematic review and meta-analysis was to appraise and combine the available systematic reviews reporting nonunion incidence and prevalence in foot and ankle arthrodesis procedures.
The Cochrane Library and MEDLINE were searched for relevant systematic from inception to January 2022. Two independent reviewers selected and reviewed eligible studies. Studies were included if they were systematic reviews or meta-analyses reporting nonunion incidence and prevalence in foot or ankle arthrodesis procedures. Fourteen systematic reviews of eight types of joint arthrodesis procedures were included for meta-analysis. These reviews comprised 138 studies with 5,793 joint arthrodesis procedures. Quality of the included reviews were assessed using the AMSTAR2 checklist. Overall and subgroup meta-analysis of prevalence were performed using random effects model. Publication bias was determined by evaluation of a doi plot with the Luis Furuya-Kanamori (LFK) index of asymmetry.
The pooled prevalence for foot and ankle nonunion rate was 8.1% (95% CI, 6.5 – 9.9%). Overall prevalence of nonunion for single joint foot and ankle joint arthrodesis was 6.1% (95% CI 4.8 – 7.6%). Subgroup analysis found that the highest rate of nonunion occurred during tibiotalocalcaneal arthrodesis with 27.1% (95% CI, 19.4–35.2%).
We have reported the first meta-analysis of systematic reviews on nonunion rates in foot and ankle arthrodesis procedures. The overall nonunion rate for foot and ankle arthrodesis procedures was 8.1%. For single joint fusion procedures, the nonunion prevalence was 6.1%. Our reported nonunion rates are lower than previously published numbers.
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NewsBot · Jun 7, 2022

Talo-Navicular and Calcaneo-Cuboid Fusion with PEEK H-pode TM vs. Titanium Maxlock TM Locking Plates: Comparison of Functional and Radiographic Outcomes
Julien Roger et al
Orthop Traumatol Surg Res. 2022 Jun 2;

Background: Locking plates are increasingly used to achieve hindfoot fusion. The objective of this study was to compare hindfoot fusion outcomes with the PEEK H-podeTM (BiotechTM) locking plate and the titanium MaxlockTM (Tornier-WrightTM) locking plate.

Hypothesis: A polyetheretherketone (PEEK) H-podeTM locking plate provides similar fusion rates to a titanium MaxlockTM locking plate for talo-navicular and calcaneo-cuboid arthrodesis.

Methods: We conducted a retrospective comparative study in 39 patients (including 21 [54%] with pes planovalgus and 11 [28%] with neurological equinovarus deformities) who underwent talo-navicular and/or calcaneo-cuboid fusion, usually combined with subtalar fusion. The first 17 patients (January 2014-February 2016) were managed with MaxlockTM locking plates and the next 22 patients (March 2016-August 2018) with H-podeTM locking plates. These two cohorts of consecutive patients were comparable regarding age, sex distribution, body mass index, and comorbidities. At last follow-up more than 1 year after surgery, we compared functional scores, pain intensity, and fusion assessed by radiographs and computed tomography (CT) (threshold set at 33%).

Results: Mean follow-up was 42 months (range, 34-63 months) in the MaxlockTM group and 25 months (range, 12-36 months) in the H-podeTM group. At last follow-up, the two groups were not significantly different for the mean values of the American Orthopedic Foot & Ankle Society score, European Foot & Ankle Society score, and visual analogue scale pain score. Neither were the two groups significantly different for talo-navicular and calcaneo-cuboid fusion by CT. In the MaxlockTM group, we found non-significant trends towards a higher proportion of patients with talo-navicular non-union (18% vs. 5% in the H-podeTM group) and weaker talo-navicular fusion in patients with pes planovalgus (60.8% vs. 82.0%, respectively). Radiographic results overestimated the fusion rates.

Discussion: Talo-navicular and calcaneo-cuboid fusion was not significantly different with H-podeTM and MaxlockTM locking plates. CT was more accurate than standard radiography to assess fusion. These results underline the usefulness of PEEK locking plates for talo-navicular and calcaneo-cuboid fusion; moreover, the radiolucency of PEEK facilitates the interpretation of radiographs.
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NewsBot · Jul 25, 2022

Subtalar Arthrodesis Union Rates With and Without Adjacent Ankle Arthrodesis
Toby Jennison et al
Foot Ankle Int. 2022 Jul 22

Background: Subtalar arthrodesis is the surgical procedure commonly performed to treat subtalar arthritis. Subtalar arthrodesis may have a higher nonunion rate if there is a preexisting adjacent joint arthrodesis. The aim of this retrospective cohort study was to compare the subtalar arthrodesis union rate of patients with native tibiotalar joints to that of patients with prior tibiotalar arthrodesis. The secondary aim was to assess risk factors for nonunion.

Methods: A retrospective cohort study of consecutive patients that underwent a subtalar arthrodesis in a single center between 2010 and 2020. The primary outcome of union was determined based on bridging callus on radiographs and clinical symptoms. If there was uncertainty, then a nonweightbearing CT was acquired. Chi-squared test and Mann-Whitney tests compared differences in demographics and risk factors for nonunion between groups. A logistical regression model was performed to determine risk factors for nonunion.

Results: Eighteen patients had an adjacent ankle arthrodesis and 53 patients did not. The successful subtalar arthrodesis union rate in those with a preexisting ankle joint arthrodesis (44.4%) was approximately half that in those without an ankle joint arthrodesis (86.8%) (P < .001). On multivariate logistic regression, an adjacent ankle arthrodesis was the only significant risk factor for nonunion. The odds ratio of nonunion of the subtalar joint with an adjacent ankle arthrodesis present was 4.90 (95% CI 1.02-23.56) compared to a subtalar arthrodesis with a native ankle joint. In addition, 9.4% of patients without an ankle arthrodesis underwent a revision subtalar arthrodesis compared with 44.4% of those with an adjacent ankle arthrodesis (P = .001).

Conclusion: In our study, we found that patients undergoing a subtalar arthrodesis with an adjacent ankle arthrodesis have a significantly increased risk of nonunion compared with those undergoing a subtalar arthrodesis with a native ankle. Patients with a previously fused ankle need counseling about the high risk of nonunion and potential additional surgery.
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NewsBot · Aug 15, 2022

Modified Posterior 2-Portal Technique of Arthroscopic Subtalar Joint Arthrodesis: Improved Pain and Functional Outcome at Mean 15 Months Follow-up—A Case Series
Nitesh Gahlot, Kishor Kunal & Abhay Elhence
Indian Journal of Orthopaedics (2022)

Introduction
Posterior arthroscopic subtalar joint arthrodesis (PASTA) via a posterior 2-portal technique has been described. We modified the surgical technique of creating the portals in the plane of the posterior facet (under fluoroscopy guidance) to enhance the ease of access to the joint, easier and complete removal of articular cartilage along with maintaining the heel height.

Methods
Patients of post-traumatic subtalar joint arthritis, treated by PASTA during 2016 till 2019 were included in the study. Exclusion criteria: significant height collapse of calcaneum, lateral blow out or heel widening. The confirmation of subtalar joint as the source of pain was done by injection of local anaesthetic inside the joint under the image intensifier, bringing immediate pain relief. The primary outcome variables assessed were the pain and functional scores, assessed using visual analogue scale and AOFAS (American Orthopaedic Foot and Ankle Society) score, respectively.

Results
The total of 16 patients (7 males, 9 females) was included. The average age was 40.68 years (23–58 years). The underlying pathology in all patients was post-traumatic subtalar arthritis secondary to calcaneus fracture malunion in 8 patients (50%), talus fracture malunion in 4 (25%) and ligament injury in 2 patients (12.5%). No bone grafting was done. The mean duration of follow-up was 15.6 months (9–24 months). There was a statistically significant improvement (p < 0.001) in mean VAS score at follow up (2; range 0–4) as compared to the mean preoperative score (7; range 6–9). The AOFAS score also improved significantly (p < 0.001) at the follow up (mean 79; range 68–89) as compared to the preoperative score (mean 18; range 10–25).

Conclusion
The posterior arthroscopic fusion of subtalar joint gives good results in terms of pain relief and functional scores when done for carefully selected patients of subtalar joint arthritis. Our slight modification of the original technique improves the ease of removing cartilage from subtalar joint with minimal height loss; thus, precluding any need for bone graft. It also makes the instrument movement easier inside the joint.
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NewsBot · Dec 13, 2022

Change in Height Following Tibiotalocalcaneal Arthrodesis: Retrospective Radiographic Analysis
Bryanna D Vesely et al
J Foot Ankle Surg. 2022 Nov 20

Tibiotalocalcaneal arthrodesis (TTCA) with an intramedullary rod is a viable treatment option for a myriad of pathologies involving the foot and ankle. While the current literature has focused on fixation techniques, deformity correction, and clinical outcomes, we are unaware of any studies specifically examining change in height following a TTCA. In the present study, we retrospectively analyzed radiographs with novel radiographic techniques to determine the change in height from preoperative to postoperative radiographs following TTCA. Patients were divided into 3 categories: Charcot, arthritis, and pes planus as the indication for surgical intervention. We found that Charcot and arthritis had an average decrease in height on anterior and posterior measurements of the height from the distal tibia to the calcaneus, while pes planus had an increase in height. The average Charcot change in height was -12.0 ± 24.4 mm anteriorly and -7.6 ± 15.5 mm posteriorly. The average change in height for the arthritis group was -6.9 ± 6.7 mm anteriorly and -3.8 ± 5.8 mm posteriorly. The pes planus group was found to have an average increase in height 0.5 ± 8.0 mm anteriorly and 2.9 ± 5.8 mm posteriorly. Overall, we found a statistically significant difference in height change between the 3 groups in anterior measurements (p = .012) and posterior measurement (p = .006). We recommend surgeons who perform this procedure to be aware of the potential change in height to better tailor surgical and postoperative care.
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NewsBot · Jan 16, 2023

A Comparative Study of Foot Range of Motion and Activities of Daily Living Status of Patients Following Ankle Arthrodesis and Tibiotalocalcaneal Arthrodesis
Kota Watanabe et al
J Foot Ankle Surg. 2022 Dec 29

Subtalar arthrodesis in addition to ankle arthrodesis (AA) should have effect on foot motion and functional capabilities pertaining to activities of daily living (ADL); however, it is not well characterized. We compared the foot range of motion and ADL-related functional capabilities between patients who had undergone AA and tibiotalocalcaneal arthrodesis (TTC). Twenty-one AA patients and 10 TTC patients were enrolled. Foot sagittal motion arc was measured by radiographs. Patient satisfaction, ADL, footwear restriction, and rating scale scores were compared between the 2 groups. The mean sagittal motion arc in the AA group (23.5 ± 6.2°) was significantly greater than that in the TTC group (15.3 ± 3.5°). Patient satisfaction and overall ADL status was comparable in the 2 groups. Difficulties in climbing stairs, wearing rubber boots, and sitting in cross-legged position were more frequently reported in the TTC group. Our findings may be valuable for both surgeons and patients in predicting post-treatment ADL status and avoiding over expectations.
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NewsBot · Feb 14, 2023

What Is The Best Fixation Technique For Isolated Talonavicular Arthrodesis? - A Systematic Review
Vinodh Arumugam et al
The Foot; 10 February 2023, 101966

Highlights
•Various fixation devices have been reported for talonavicular arthrodesis, however there is no gold standard.
•9 studies highlighted for review with high rates of union demonstrated regardless of fixation technique.
•All reviewed studies rated as serious risk for bias with small sample sizes and inconsistent methodology.
•Plate plus screw fixation is deemed most promising considering the limited clinical data and reviewed biomechanical studies.
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Summary
Talonavicular arthrodesis is associated with a rate of non-union that ranges from 3-37%. Various fixation devices have been reported for talonavicular arthrodesis including screws, staples, plates, K-wires and intraosseous fix systems, however there is no definitive gold standard. This systematic review aims to compare clinical outcomes between different fixation devices for talonavicular arthrodesis.

Methods
MEDLINE, EMBASE, CENTRAL and Google Scholar were reviewed for studies reporting on outcomes of different fixation techniques for talonavicular arthrodesis indicated for osteoarthritis, inflammatory and post-traumatic arthritis from 1946 to 2021. The primary outcome measure was union rate. Secondary outcome measures included functional improvement, cost, quality of life and patient satisfaction.

Results
9 articles involving 141 cases of talonavicular arthrodesis were identified. Fusion rates were as follows: screw fixation (n=75): 87.5% to 100%, staple fixation (n=13): 100%, intraosseous fix system (n=16): 100%, and K-wire fixation (n=2): 100%. One study utilised a dorsal locking plate with two supplemented compression screws (n=9, fusion rate= 100%) and two studies used a combination of screws with staples (n=26, fusion rate= 96%). 7 of 9 studies measured functional outcomes and pain relief with improvement demonstrated in all fixation techniques. Quality of life, satisfaction and cost were inadequately reported amongst the included studies. All studies were rated as serious risk of bias.

Conclusion
This systematic review consolidates the evidence for outcomes of different fixation techniques for TN arthrodesis, however a definitive judgement regarding the best fixation technique is unobtainable from current clinical evidence, due to lack of high-quality studies.

With review of biomechanical studies and the limited clinical data, fixation with plate plus screw is most promising and would warrant further comparative study.
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NewsBot · Feb 21, 2023

Biomechanical comparison of nitinol compression staples versus fully threaded lag screws for talonavicular arthrodesis
P.J. Reddy, B.T. Manning, W. Bezold, A. Garlapaty, J.L. Cook, K. Schweser
Journal of Orthopaedics; Volume 37, March 2023, Pages 64-68

Background
Talonavicular arthrodesis (TNA) is indicated for treatment of disorders that require immobilization of the hindfoot. Lag screw fixation is considered the reference standard technique for TNA. Despite consistently favorable clinical results using lag screw fixation, it is still associated with higher than desired complication and failure rates. Nitinol compression staples have been used for TNA based on potential advantages over lag screw fixation. However, functional biomechanical data comparing lag screw and nitinol compression staples for TNA are lacking. Therefore, the objective of this study was to compare nitinol compression staples to fully threaded lag screws for use in TNA with respect to their biomechanical properties during functional robotic testing.

Methods
TNA was performed on cadaveric feet (n = 12; 6 matched pairs) using either two nitinol compression staples (Arthrex, Naples, FL) or two fully threaded lag screws (Arthrex, Naples, FL) in random order, alternating between paired left and right feet. After instrumentation, specimens were mounting in a robotic testing system and loaded at 89 N/sec from 30 N to 445 N for 1 min. Then, continuous compressive load of 445 N was applied while cycling from 30° plantarflexion to 15° dorsiflexion for 10 cycles. Optical tracking markers attached to the talus and navicular bone tracked displacements. Translation data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p < 0.05) differences between fixation methods were determined using paired t-Tests for each measured variable.

Results
There were no statistically significant differences between staples and screws for translation in X, Y, or Z planes. When comparing rotation (roll, pitch, and yaw), there were no statistically significant differences with the exception of increased roll rotation for staple fixation versus lag screw fixation during static compression testing (p = 0.009).

Conclusion
Based on comparison to the reference standard lag screw fixation for clinically relevant biomechanical properties measured during functional robotic testing of the hindfoot, nitinol compression staples are a viable option for talonavicular arthrodesis.
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NewsBot · May 14, 2023

Preservation of the Subtalar Joint Determines Outcomes in a 10-Year Evaluation of Ankle Arthrodesis
Rebecca Sell et al
J Clin Med. 2023 Apr 25;12(9):3123

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.
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NewsBot · May 14, 2023

Does the Number of Screws Influence the Union Rate in Ankle Arthrodesis? A Meta-analysis and Systematic Review
Antonio Izzo et al
Foot Ankle Spec. 2023 May 11

Objective: The purpose of this study was to determine whether the number of cannulated screws used during ankle arthrodesis (AA) might influence the union and complication rate.

Methods: In this Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant PROSPERO-registered systematic review, multiple databases were searched including studies in which patients undergone AA using cannulated screws as exclusive fixation method were followed. Data were harvested regarding the cohort, the study design, the surgical technique, the nonunion, and complication rate at the longest follow-up. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). Two groups were built (arthrodeses fixed with 2 screws [group 1, G1] vs arthrodeses fixed with 3 screws [group 2 G2]) and compared.

Results: Fifteen series of patients from 15 studies (667 ankles) were selected (G1 = 458 ankles and G2 = 209). The pooled proportion estimate revealed a similar nonunion rate in the 2-screw group as compared with the 3-screw group (4% vs 3%; P = .68). The pooled proportion of complications was higher in G1 (19%) than in G2 (8%), but it was not significantly different either (P = .45). After exclusion of "symptomatic hardware and screw removal," the difference was still not significant (P = .28) although it resulted lower in G1 than in G2 (4% vs 8%, respectively).

Conclusions: Using 3 cannulated screws during AA as compared with a 2-screw construct does not significantly reduce the risk of nonunion nor the risk of complications.
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NewsBot · Jan 8, 2024

Comparison of the Acute Postoperative Complications Between Isolated Talonavicular Versus Talonavicular and Subtalar (Double) Arthrodesis in Flatfoot Deformity
Yianni Bakaes et al
Foot Ankle Spec. 2024 Jan 7

Background: Both isolated talonavicular arthrodesis and talonavicular and subtalar (such as double) arthrodesis can be effective treatments for adult-acquired flatfoot deformity (AAFD) with good success rates, but double arthrodesis has become more commonly performed in recent years. The purpose of this study is to evaluate whether isolated talonavicular versus talonavicular and subtalar arthrodesis led to significantly different 30-day postoperative complication rates in patients with AAFD.

Methods: We performed a retrospective review to identify a large cohort of adult patients with the diagnosis of AAFD or posterior tibial tendon deformity (PTTD) who underwent isolated talonavicular or talonavicular and subtalar arthrodesis between 2006 and 2020 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). To investigate whether there was a difference in complication rate between the 2 surgical cohorts, we estimated logistic regression models and log-binomial models on each of the outcomes while also adjusting for sex and age.

Results: We found that there was no significant difference in the rate of major complications (P = .567) or readmissions (P = .567) between patients who underwent isolated talonavicular versus talonavicular and subtalar arthrodesis for AAFD. However, there was a significantly higher rate of minor complications in patients who underwent isolated talonavicular arthrodesis when compared with patients who underwent talonavicular and subtalar arthrodesis (P = .009).

Conclusion: This study found that there was no increased risk of 30-day postoperative complications or readmissions with talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis for AAFD. In addition, there was no increased risk of major complications for talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis, and isolated talonavicular arthrodesis actually carried a higher risk of minor complications for this surgical cohort. This may provide valuable information for surgeons considering surgical treatment for a particular case of AAFD.
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NewsBot · Feb 10, 2024

Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion
Matthew T Yeager et al
Foot Ankle Int. 2024 Jan 28

Background: The stability of the hindfoot greatly relies on the integrity of the talonavicular joint. Pathologies affecting this joint often necessitate fusion. Our study explores the risks posed to neurovascular and tendon structures during simulated percutaneous talonavicular joint preparation for fusion.

Methods: In 9 fresh cadaver specimens, the talonavicular joint was accessed through two portals. A 2-mm Shannon burr was employed for joint surface preparation with distraction provided by a pin-based distractor. Dissections were performed to assess potential damage to critical structures, including the dorsalis pedis artery, superficial and deep peroneal nerves, extensor hallucis longus (EHL), and tibialis anterior (TA) tendons.

Results: The dorsal portal site was found to be significantly closer to important structures compared to the medial portal site. The Shannon burr made contact with various structures, with a single transection identified for both deep and superficial peroneal nerve branches. During the dorsal portal site approach, potential injury to the EHL tendon was identified as concern.

Conclusion: This study sheds light on the potential risks associated with percutaneous dorsal and medial joint preparation approaches using a Shannon burr.Level of Evidence:Level V, mechanism-based reasoning..
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Results of triple arthrodesis

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Cortexi Canada :- The Worth Trying Recipe For Best Results

MRI results question

Thoughts on my MRI results?

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MRI results..

Measuring and recording Supination Resistance Test Results clinically

Bone scan results translation ?

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Results of triple arthrodesis

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Cortexi Canada :- The Worth Trying Recipe For Best Results

MRI results question

Thoughts on my MRI results?

Ankle MRI results help

MRI results..

Measuring and recording Supination Resistance Test Results clinically

Bone scan results translation ?

Share This Page

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