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Traynor CJ, Zhang H, Den Hartog BD, Seybold JD, Engasser WM, McGaver RS, Fritz JE, Seiffert KJ, Dock CC, Coetzee JC. Isolated Talonavicular Arthrodesis as Treatment for Flexible Progressive Collapsing Foot Deformity: A Case Series. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241235672. [PMID: 38516057 PMCID: PMC10956151 DOI: 10.1177/24730114241235672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background For the younger, more active patient with flexible symptomatic progressive collapsing foot deformity (PCFD), joint-sparing procedures may be preferred to preserve functional motion. Isolated talonavicular (TN) arthrodesis has been described for treatment of rigid and flexible PCFD for patients that are older and less active whose deformity is still correctable through the TN joint. The purpose of this study was to evaluate radiographic and clinical outcomes in patients with PCFD treated with isolated triplanar correction with a TN joint arthrodesis. Methods Forty-nine patients (53 feet) with flexible PCFD underwent isolated TN arthrodesis. Weightbearing radiographs were performed pre- and postoperatively, and measurements included lateral talar-first metatarsal angle, calcaneal pitch, TN coverage angle, and the anteroposterior (AP) talar-first metatarsal angle. The Foot and Ankle Ability Measure (FAAM) and Veterans-Rand 12-Item Health Survey (VR-12) scores were also collected. Results Thirty-five females and 14 males were evaluated with a mean age of 63 years, at an average follow-up of 41.3 months. Significant improvements were found radiographically. Lateral radiographs demonstrated improvements in lateral talar-first metatarsal angle from 25.2 degrees preoperatively to 9.5 degrees postoperatively (P < .001) and calcaneal pitch from 14.9 degrees preoperatively to 17.5 degrees postoperatively (P < .001). AP radiographs showed the TN coverage angle improving from 35.0 degrees to 4.9 degrees postoperatively (P < .001) and AP talar-first metatarsal angle improving from 17.3 degrees to 5.9 degrees postoperatively (P < .001). Clinical outcomes were improved in the FAAM pain score (48.6 to 39.2, P = .130), FAAM ADL score (53.8 to 69.2, P = .002), FAAM Sport score (29.5 to 40.7, P = .099), and the overall FAAM score (47.7 to 63.1, P = .006). Patient satisfaction with medical care was 85.2/100 postoperatively. Conclusion Isolated TN arthrodesis is a viable surgical option for older, lower-demand patients with flexible PCFD. This study demonstrated significant improvements in radiographic alignment and FAAM scores. Comparative studies with other surgical procedures should be performed to determine which is the best technique for older, lower-demand patients with flexible PCFD. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
| | - Hui Zhang
- Aurora Orthopedics, Oak Creek, WI, USA
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Lendrum JA, Hunt KJ. Medial Column Fusions in Flatfoot Deformities: Naviculocuneiform and Talonavicular. Foot Ankle Clin 2022; 27:769-786. [PMID: 36368796 DOI: 10.1016/j.fcl.2022.08.006] [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: 02/02/2023]
Abstract
Progressive collapsing foot deformity (PCFD; commonly referred to as flatfoot deformity) is a complex condition classically characterized by hindfoot valgus, midfoot abduction, and forefoot varus. Medial column arthrodesis can be used to reliably correct severe, arthritic, and unstable PCFD involving the medial column. Although both naviculocuneiform arthrodesis and talonavicular arthrodesis have their own indications, patient selection and careful radiographic and clinical assessment are crucial for any medial column arthrodesis. Herein, the authors discuss the indications for medial column arthrodesis procedures, outcomes as reported in the literature, and several case examples using medial column arthrodesis in deformity correction.
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Affiliation(s)
- James A Lendrum
- Department of Orthopedics, University of Colorado, 12631 East 17th Avenue, Mail Stop B202, Aurora, CO 80045, USA
| | - Kenneth J Hunt
- Department of Orthopedics, University of Colorado, 12631 East 17th Avenue, Mail Stop B202, Aurora, CO 80045, USA.
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Vacketta VG, Jones JM, Philp FH, Saltrick KR, McMillen RL, Hentges MJ, Catanzariti AR. Radiographic Outcomes of Talonavicular Joint Arthrodesis With Varying Fixation Techniques in Stage III Adult Acquired Flatfoot Reconstruction. J Foot Ankle Surg 2022; 61:969-974. [PMID: 35027310 DOI: 10.1053/j.jfas.2021.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/09/2021] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
Utilization of the talonavicular joint (TN) arthrodesis as an isolated procedure or in combination with hindfoot arthrodesis has been described in the literature for treatment of numerous hindfoot conditions. When used in isolation or with concomitant hindfoot arthrodesis, the TN joint has demonstrated nonunion rates reported as high as 37% in the literature. Despite previous research, there remains a lack of agreement upon the ideal fixation technique for TN joint arthrodesis with and without concomitant subtalar joint arthrodesis. The purpose of this study was to retrospectively compare the radiographic and clinical results of TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs in the treatment of advanced hindfoot malalignment in stage III adult-acquired flatfoot deformity. We retrospectively reviewed 105 patients who underwent TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs. Our results demonstrated a nonunion rate of 16.2%, with 17 nonunions identified within our patient population. One (2.4%) nonunion was observed in the 3-screw cohort, 7 (33.3%) nonunions were observed in the 2-screw cohort, 4 (16.0%) nonunions were observed in the 2-screw plus plate cohort, and 5 (29.4%) nonunions were observed in the 1-screw plus plate cohort. The difference in nonunion rate between the 4 cohorts was statistically significant. Based on these results, we conclude that the use of a 3-screw construct for TN joint arthrodesis as part of double arthrodesis procedure demonstrates a statistically significant reduction in nonunion rate and should be considered a superior fixation construct for this procedure.
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Affiliation(s)
- Vincent G Vacketta
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Jacob M Jones
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Frances Hite Philp
- Health Outcomes Researcher, Orthopaedic and Research Institutes, Allegheny Health Network, Pittsburgh, PA
| | - Karl R Saltrick
- Attending Faculty of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Ryan L McMillen
- Attending Faculty of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Matthew J Hentges
- Attending Faculty of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, 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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Stapleton JJ, Zgonis T. Hindfoot Arthrodesis for the Elective and Posttraumatic Foot Deformity. Clin Podiatr Med Surg 2017; 34:339-346. [PMID: 28576193 DOI: 10.1016/j.cpm.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Triple (talonavicular, subtalar, and calcaneocuboid) joint arthrodesis and most recently double (talonavicular and subtalar) joint arthrodesis have been well proposed in the literature for surgical repair of the elective, posttraumatic, and/or neuropathic hindfoot deformities. The articulation of the hindfoot with the ankle and midfoot is multiaxial, and arthrodesis of these joints can significantly alter the lower extremity biomechanical manifestations by providing anatomic correction and alignment. This article reviews the indications and preoperative planning for some of the most common procedures to address the hindfoot deformity.
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Affiliation(s)
- John J Stapleton
- Foot and Ankle Surgery, Lehigh Valley Hospital, 1250 South Cedar Crest Boulevard, Suite 110, Allentown, PA 18103, USA; Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Thomas Zgonis
- Division of Podiatric Medicine and Surgery, Department of Orthopaedics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC 7776, San Antonio, TX 78229, USA
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Efficiency of locking-plate fixation in isolated talonavicular fusion. Orthop Traumatol Surg Res 2016; 102:S235-9. [PMID: 27033837 DOI: 10.1016/j.otsr.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Talonavicular (TN) fusion is an effective means of treating hindfoot deformity and pain. At the cost of a certain limited morbidity, it allows lasting stabilization of all of the torque joints. Non-union rates, however, are high, due to insufficient mechanical stability of the fixation. The present study assessed radiological and clinical results in TN fusion fixed by two retrograde compression screws and a dorsal locking plate. MATERIAL AND METHOD A retrospective single-surgeon study recruited 26 TN fusions performed in 25 patients (13 male, 12 female; mean age, 54.6±15.4years) between March 1st, 2010 and February 28th, 2014. Mean follow-up was 14.9±8.7months. Bone fusion and anatomic results were assessed on dorsoplantar, lateral and Méary weight-bearing radiographs. RESULTS Radiologic fusion was achieved in all cases, at a mean 2.7±0.7months. Mean TN coverage angle was 21.7±10.5° preoperatively and 3.8±1.8° at follow-up. Mean AOFAS score improved significantly, from 37.2±11.8 (range, 20-53) preoperatively to 79.4±11.4 (range, 45-98) at follow-up. CONCLUSION TN fusion fixed by two retrograde compression screws and a dorsal locking plate provided a high rate of consolidation without loss of angular correction and with satisfactory clinical results. LEVEL OF EVIDENCE IV. TYPE OF STUDY Retrospective.
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Carranza-Bencano A, Tejero S, Fernández Torres JJ, Del Castillo-Blanco G, Alegrete-Parra A. Isolated talonavicular joint arthrodesis through minimal incision surgery. Foot Ankle Surg 2015; 21:171-7. [PMID: 26235855 DOI: 10.1016/j.fas.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/13/2014] [Accepted: 11/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to analyze bony fusion and functional outcomes after talonavicular arthrodesis (TNA) using an original minimally invasive surgery (MIS). METHODS There was a total of 11 feet in 11 patients who underwent TNA and were followed up for 47 months (range 40.8-53.1). Functional outcomes were measured by AOFAS and quality of life by eight sections of SF-36. RESULTS Radiographic and clinical consolidation was achieved in 10 of 11 cases. In the AOFAS score, physical function improved a mean of 34.4 points (95% CI: 23.2-45.6; p<.0001) and pain improved a mean of 23.6 points (95% CI: 17.4-29.8; p<.0001). One osteoporotic and rheumatic patient had a non-union. No cases of early complications, such as wound infections, neurovascular damage or delayed wound healing, occurred. CONCLUSION Isolated TNA by MIS could be an option for the treatment of TN arthritis, especially for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- A Carranza-Bencano
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain.
| | - Sergio Tejero
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
| | - J J Fernández Torres
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
| | | | - A Alegrete-Parra
- Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
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Ebalard M, Le Henaff G, Sigonney G, Lopes R, Kerhousse G, Brilhault J, Huten D. Risk of osteoarthritis secondary to partial or total arthrodesis of the subtalar and midtarsal joints after a minimum follow-up of 10 years. Orthop Traumatol Surg Res 2014; 100:S231-7. [PMID: 24726756 DOI: 10.1016/j.otsr.2014.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The goal of this retrospective, multicentre study was to evaluate the long-term outcomes in patients who have undergone partial or total arthrodesis of the subtalar and midtarsal joints. HYPOTHESIS Secondary osteoarthritis of the adjacent joints can negatively affect the outcomes more than 10 years after these fusion procedures. MATERIAL AND METHODS The outcomes of 72 fusions (total: 22; partial: 50) performed between 1981 and 2002 were evaluated using the Maryland Foot Score (MFS), self-evaluation questionnaire and three weight-bearing X-ray views (Meary's with cerclage wire around heel, lateral and dorsoplantar). The average follow-up was 15 ± 5 years (range 10-31). RESULTS There were two deep infections that resolved after lavage and antibiotics therapy. There were 21 early complications (10 complex regional pain syndrome, 7 delayed wound healing, 2 superficial infections, 2 venous thrombosis) that all resolved. There were five cases of non-union (6.9%) that healed after being re-operated. After five years, secondary osteoarthritis led to the fusion being extended to the tibotalar joint (1 case) and midtarsal joint (1 case). At the last follow-up, the average MFS was 71.5 (range 25-100). Patient deemed the result as either excellent (10%), very good (9%), good (55%), poor (19%) or bad (7%). Pain at the last follow-up was present in 84% of cases. The rear-foot was normally aligned in 45% of cases, varus aligned in 22% and valgus aligned in 33%. The MFS was significantly better in patients with normal alignment. Patients with neurological foot disorders had significantly more preoperative (80% cavovarus) and postoperative foot deformity (P<0.05). At the last follow-up, the rate of secondary osteoarthritis in the surrounding joints was elevated: 73% tibiotalar, 58.3% subtalar, 65.8% talonavicular, 53.5% calaneocuboid. The presence of osteoarthritis was not correlated with pain or lower MFS. However there was significantly more pain at last follow-up than at 12 months postoperative and two fusions were required in patients with secondary osteoarthritis. CONCLUSION Although partial or total arthrodesis of the subtalar and midtarsal joints is a reliable procedure, it induces secondary osteoarthritis. Even though it seems to be well tolerated more than 10 years after the initial procedure, this possibility must be discussed with young, active patients. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- M Ebalard
- Orthopaedic and Trauma Surgery Department, CHU Rennes, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - G Le Henaff
- Orthopaedic and Trauma Surgery Department, CHU Brest, hôpital La-Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
| | - G Sigonney
- Orthopaedic and Trauma Surgery Department, CHU Rouen, hôpital Charles-Nicolle, pavillon Dève, 1, rue de Germont, 29000 Brest, France
| | - R Lopes
- Orthopaedic and Trauma Surgery Department, CHU Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes, France
| | - G Kerhousse
- CHP Saint-Grégoire, Orthopaedic Surgery Department, 36, boulevard de la Boutière, 35760 St-Grégoire, France
| | - J Brilhault
- Orthopaedic and Trauma Surgery Department, CHU de Tours, hôpital Trousseau, 37044 Tours, cedex 09, France
| | - D Huten
- Orthopaedic and Trauma Surgery Department, CHU Rennes, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
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Kanzaki N, Nishiyama T, Fujishiro T, Hayashi S, Takakura Y, Takakura Y, Kurosaka M. Osteoarthritis of the talonavicular joint with pseudarthrosis of the navicular bone: a case report. J Med Case Rep 2011; 5:547. [PMID: 22059798 PMCID: PMC3225353 DOI: 10.1186/1752-1947-5-547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/08/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Osteoarthritis of the talonavicular joint caused by inflammatory, degenerative, and post-traumatic arthritis has been commonly described, and isolated arthrodesis for talonavicular joint has usually been performed for such conditions. However, arthritis accompanied by pseudarthrosis of the navicular bone is an extremely rare case, and to the best of our knowledge, isolated arthrodesis for this situation has not been previously described in any published reports. Case presentation The patient was a 39-year-old Japanese man. He had complained of pain in his left middle foot since a fall from his motorcycle six months previously. Radiographs and computed tomography (CT) scans revealed pseudarthrosis of the navicular bone. MRI indicated mild arthritic change in the talonavicular joint and avascular necrosis of the navicular bone. We performed an isolated arthrodesis of the talonavicular joint with two 6.5 mm cancellous screws. One year after the operation, radiographical bone union had been obtained, and the patient reported no pain and complete satisfaction with the result. Conclusions Isolated talonavicular arthrodesis is one of the effective procedures for the treatment of traumatic talonavicular arthritis with pseudarthrosis of the navicular bone both in providing pain relief and functional improvement.
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Affiliation(s)
- Noriyuki Kanzaki
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Tyuo-Ku, Kobe, 650-0017, Japan.
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Barg A, Brunner S, Zwicky L, Hintermann B. Subtalar and naviculocuneiform fusion for extended breakdown of the medial arch. Foot Ankle Clin 2011; 16:69-81. [PMID: 21338931 DOI: 10.1016/j.fcl.2010.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Combined subtalar and naviculocuneiform fusion was successful in restoring the longitudinal medial arch after extended breakdown while preserving the talon avicular joint. This surgical technique was shown to give a reliable fusion and biomechanically stable position of the foot. In this review article, we summarize the medial column procedures for flatfoot deformity and present our surgical technique and results of 10 consecutive patients treated with this method at a minimum 1-year follow-up.
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Affiliation(s)
- Alexej Barg
- Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
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