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Raykov G, Ivanov S, Gueorguiev B, Pastor T, Berk T, Pastor T, Zderic I. Optimizing Subtalar Arthrodesis: A Human Cadaveric Evaluation of a Novel Partially-Threaded Screw Combination in the Delta Configuration. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:844. [PMID: 38929461 PMCID: PMC11206027 DOI: 10.3390/medicina60060844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Despite the established role of subtalar joint arthrodesis (SJA) for treatment of subtalar osteoarthritis, achieving bone union remains challenging, with up to 46% non-union rates. Adequate compression and stable fixation are crucial for successful outcomes, with internal screw fixation being the gold standard for SJA. The delta configuration, featuring highly divergent screws, offers stability, however, it can result in hardware irritation in 20-30% of patients. Solutions to solve this complication include cannulated compression screw (CCS) countersinking or cannulated compression headless screw (CCHS) application. The aim of this biomechanical study was to investigate the stability of a delta configuration for SJA utilizing either a combination of a posterior CCHS and an anterior CCS or a standard two-CCS combination. Materials and Methods: Twelve paired human cadaveric lower legs were assigned pairwise to two groups for SJA using either two CCSs (Group 1) or one posterior CCHS and one anterior CCS (Group 2). All specimens were tested under progressively increasing cyclic loading to failure, with monitoring of the talocalcaneal movements via motion tracking. Results: Initial stiffness did not differ significantly between the groups, p = 0.949. Talocalcaneal movements in terms of varus-valgus deformation and internal-external rotation were significantly bigger in Group 1 versus Group 2, p ≤ 0.026. Number of cycles until reaching 5° varus-valgus deformation was significantly higher in Group 2 versus Group 1, p = 0.029. Conclusions: A delta-configuration SJA utilizing a posterior CCHS and an anterior CCS is biomechanically superior versus a standard configuration with two CCSs. Clinically, the use of a posterior CCHS could prevent protrusion of the hardware in the heel, while an anterior CCS could facilitate less surgical time and thus less complication rates.
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Affiliation(s)
- Georgi Raykov
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Surgery, Cantonal Hospital of Uri, 6460 Altdorf, Switzerland
| | - Stoyan Ivanov
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Orthopedics and Traumatology, Saint Marina Regional Hospital, Medical University Varna, 9002 Varna, Bulgaria
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
| | - Tatjana Pastor
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3007 Bern, Switzerland
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Orthopedics, Traumatology and Reconstructive Surgery, University Hospital Aachen, 52074 Aachen, Germany
| | - Torsten Pastor
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
- Department of Orthopedics and Traumatology, Luzern Regional Hospital, 6110 Wolhusen, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, 7270 Davos, Switzerland; (S.I.); (B.G.); (T.P.); (T.P.); (I.Z.)
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Lundin TPO, Pujari-Palmer M, Svensson G, Höglund OV. Canine ex vivo tarsal arthrodesis: fixation by using a new bone tissue glue. Front Vet Sci 2023; 10:1250147. [PMID: 37799403 PMCID: PMC10548131 DOI: 10.3389/fvets.2023.1250147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Arthrodesis, performed as a salvage surgical procedure to treat intractable joint conditions in dogs and cats, is associated with a high incidence of complications intra and postoperative, proving the need for improved and new techniques in arthrodesis surgery. Adding a new resorbable bone glue to the arthrodesis could potentially add fixation strength and lower complications. The objectives of this experimental ex vivo biomechanical study were therefore to develop a biomechanical test model of partial tarsal arthrodesis and to determine whether the new resorbable bone glue (phosphoserine modified cement) produced measurable fixation strength in canine calcaneoquartal arthrodesis, without orthopedic implants. Methods Four biomechanical test models with a total of 35 canine tarsal joints were used. Soft tissues were dissected to 4 different test models with variable contributions from soft tissues. The calcaneoquartal joint was prepared as in vivo arthrodesis and the glue was applied to joint surfaces as a liquid/putty (0.4 cc). After curing for 24 h, a shear force was applied to the joint (1 mm per minute) and the failure strength was recorded. Results Calcaneoquartal joints, where all soft tissues had been completely resected and fixated with glue (1-1.5 cm2 joint surface), withstood 2-5 mm of displacement and an average of 100 ± 58 N/cm2 of shear force (Model 1). Similar adhesive fixation strengths were obtained in Model 2 and 3 with increasing contributions from soft tissues (80 ± 44 and 63 ± 23 N/cm2, p = 0.39, ANOVA). Conclusion The developed biomechanical model was sensitive enough to measure differences in fixation strengths between different glue formulations. The average fixation strength (60-100 N/cm2) should be strong enough to support short-term load bearing in medium sized canines (20 kg). The developed cadaver biomechanical test model is of potential use for other arthrodesis studies. The new resorbable glue can potentially contribute to stability at arthrodesis surgery, acting as a complement to today's standard fixation, metal implants.
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Affiliation(s)
| | - Michael Pujari-Palmer
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Gustaf Svensson
- Department of Surgery, Blå Stjärnans Djursjukhus, Gothenburg, Sweden
| | - Odd Viking Höglund
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Guareschi AS, Hoch C, Reid JJ, Scott DJ, Gross CE. Surgical Construct Type Is Associated With Time to Fusion and Reoperation Rate in Double and Isolated Talonavicular Arthrodeses. Foot Ankle Spec 2023:19386400231162422. [PMID: 37002611 DOI: 10.1177/19386400231162422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND This study evaluates the effect of surgical construct on postoperative outcomes in patients undergoing isolated talonavicular (TN) or double (TN and subtalar ST) arthrodesis. TN constructs included plate and screw, screw and staple, and isolated staple constructs. Subtalar constructs included 1- and 2-screw constructs. METHODS Retrospective chart review identified 52 patients who underwent double or isolated TN arthrodesis between 2016 and 2021 by a single fellowship-trained foot and ankle surgeon with minimum 6 months of follow-up (mean = 1.62 years, range = 0.50-4.39 years). Data collected included demographics, medical history, surgical indication, surgical constructs used, complications, reoperations, patient-reported outcome measures, and radiographic measures. RESULTS Overall complication and reoperation rates were 26.3% and 12.3%, respectively. Among TN constructs, time to ST (P = .026) and TN (P = .018) fusion was significantly slower among patients receiving a plate and screw construct. Complication rate did not differ, but reoperation rate was significantly higher for plate and screw TN constructs (P = .039). Postoperative Foot and Ankle Outcome Score (FAOS) Quality of Life (P = .028) and Total (P = .016) scores were significantly better among plate and screw TN constructs. CONCLUSION Utilization of screw and staple or isolated staple construct have significantly quicker time to fusion and lower reoperation rates than plate and screw constructs for the TN joint. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
| | - Caroline Hoch
- Medical University of South Carolina, Charleston, South Carolina
| | - Jared J Reid
- Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Scott
- Medical University of South Carolina, Charleston, South Carolina
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Jones JM, Vacketta VG, Philp FH, Catanzariti AR. Radiographic Outcomes of Isolated Subtalar Joint Arthrodesis With Varying Fixation Technique. J Foot Ankle Surg 2022; 61:938-943. [PMID: 34996652 DOI: 10.1053/j.jfas.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
Subtalar joint (STJ) arthrodesis is a well-established and accepted surgical procedure utilized for the treatment of various hindfoot conditions including primary or posttraumatic subtalar osteoarthritis, hindfoot valgus deformity, hindfoot varus deformity, complex acute calcaneal fracture, symptomatic residual congenital deformity, tarsal coalition, and other conditions causing pain and deformity about the hindfoot. Union rates associated with isolated subtalar joint arthrodesis are generally thought to be favorable, though reports have varied significantly, with non-union rates ranging from 0 to 46%. Various fixation constructs have been recommended for STJ arthrodesis. The purpose of this study was to compare radiographic union in a 2-screw fixation technique to a 3-screw fixation technique for patients undergoing primary isolated STJ arthrodesis. To this end, we retrospectively reviewed 54 patients; 26 in the 2-screw group and 28 in the 3-screw group. We found the median time to radiographic union to be 9 weeks for the 2-screw cohort and 7 weeks for the 3-screw cohort. Additionally, we found that the 2-screw fixation cohort had a radiographic non-union rate of 26.9% while the 3-screw cohort had no non-unions. We conclude that the use of a 3-screw construct for isolated STJ arthrodesis has a lower non-union rate and time to union when compared to the traditional 2-screw construct and should be considered as a fixation option for STJ arthrodesis.
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Affiliation(s)
- Jacob M Jones
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Vincent G Vacketta
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Frances Hite Philp
- Health Outcomes Researcher, AHN Research and Orthopaedic Institutes, Allegheny Health Network, Pittsburgh, PA
| | - Alan R Catanzariti
- Director of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
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Verheyen CCPM. Letter to the editor on "How many screws are necessary for subtalar fusion? A retrospective study". Foot Ankle Surg 2020; 26:948. [PMID: 32978086 DOI: 10.1016/j.fas.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Cees C P M Verheyen
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
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Wirth SH, Viehöfer A, Fritz Y, Zimmermann SM, Rigling D, Urbanschitz L. How many screws are necessary for subtalar fusion? A retrospective study. Foot Ankle Surg 2020; 26:699-702. [PMID: 31522872 DOI: 10.1016/j.fas.2019.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Biomechanical studies have shown a higher compressive force and higher torsional stiffness for fixation with three screws compared to two screws. However, clinical data to compare these fixation techniques is still lacking. METHODS A retrospective analysis of 113 patients was performed, who underwent isolated subtalar fusion between January 2006 and April 2018. RESULTS Revision arthrodesis was required in 8% (n=6/36) for 3-screw-fixation and 38% (n=35/77) for 2-screw-fixation. For 3-screw-fixation, non-union, was observed in 14% (n=5/36) compared to 35% (n=27/77) in 2-screw fixation. Non-union (p=.025) and revision arthrodesis (p=.034) were significantly more frequent in patients with 2 screws. A body mass index ≥30kg/m2 (p=.04, OR=2.6,95%CI:1.1-6.3), prior ankle-fusion (p=.017,OR=4.4,95%CI:1.3-14.5) and diabetes mellitus (p=.04,OR=4.9,95%CI:1.1-17.8) were associated with a higher rate of revision arthrodesis. CONCLUSIONS Our findings suggest that successful subtalar fusion is more reliably achieved with use of three screws. However, future prospective studies will be necessary to further specify this recommendation.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopedics, University Hospital Balgrist, Zürich, ZH, Switzerland
| | - Arnd Viehöfer
- Department of Orthopedics, University Hospital Balgrist, Zürich, ZH, Switzerland
| | - Yannick Fritz
- Department of Orthopedics, University Hospital Balgrist, Zürich, ZH, Switzerland
| | - Stefan M Zimmermann
- Department of Orthopedics, University Hospital Balgrist, Zürich, ZH, Switzerland
| | - Dominic Rigling
- Department of Orthopedics, University Hospital Balgrist, Zürich, ZH, Switzerland
| | - Lukas Urbanschitz
- Department of Orthopedics, University Hospital Balgrist, Zürich, ZH, Switzerland.
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Chaudhari N, Godoy-Santos AL, Netto CDC, Rodriguez R, Dun S, He JK, McKissack H, Fleisig GS, Pires EA, Shah A. Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis. EINSTEIN-SAO PAULO 2020; 18:e0AO5052. [PMID: 32159606 PMCID: PMC7046341 DOI: 10.31744/einstein_journal/2020ao5052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/01/2019] [Indexed: 11/08/2022] Open
Abstract
Objective To compare screw fixation strength for subtalar arthrodesis. Methods Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student’s
t
test, with p=0.05 used to determine statistical significance. Results Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). Conclusion In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.
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Affiliation(s)
| | - Alexandre Leme Godoy-Santos
- Hospital Israelita Albert Einstein , São Paulo , SP , Brazil .,Hospital das Clínicas , Faculdade de Medicina , Universidade de São Paulo , São Paulo , SP , Brazil
| | - Cesar de Cesar Netto
- University of Iowa Health Care , Carver College of Medicine , Iowa City , Iowa , United States
| | - Ramon Rodriguez
- Tulane University Orthopaedics , New Orleans , LA , United States
| | - Shouchen Dun
- University of Alabama at Birmingham , Birmingham , AL , United States
| | - Jun Kit He
- University of Alabama at Birmingham , Birmingham , AL , United States
| | - Haley McKissack
- University of Alabama at Birmingham , Birmingham , AL , United States
| | - Glenn S Fleisig
- American Sports Medicine Institute , Birmingham , AL , United States
| | | | - Ashish Shah
- University of Alabama at Birmingham , Birmingham , AL , United States
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