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Chang SH, Hagemeijer NC, Saengsin J, Kusema E, Morris BL, DiGiovanni CW, Guss D. Short-Term Risk Factors for Subtalar Arthrodesis After Primary Tibiotalar Arthrodesis. J Foot Ankle Surg 2022; 62:68-74. [PMID: 35534413 DOI: 10.1053/j.jfas.2022.04.001] [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: 02/17/2022] [Revised: 03/27/2022] [Accepted: 04/02/2022] [Indexed: 02/03/2023]
Abstract
While adjacent joint arthritis is a recognized long-term downside of primary tibiotalar arthrodesis (TTA), few studies have identified risk factors for early subtalar arthrodesis (STA) after TTA. This study aims to identify the risk factors for STA within the first few years following TTA. All patients older than 18 years undergoing TTA between 2008 and 2016 were identified retrospectively. Demographic data and comorbidities were collected alongside prior operative procedures, postoperative complications, and subsequent STA. Pre-and postoperative Kellgren-Lawrence osteoarthritis grade of the subtalar joint and postoperative radiographic alignment were obtained. A total of 240 patients who underwent primary TTA were included in this study with median follow up of 13.8 months. Twenty patients (8.3%) underwent STA after TTA due to symptomatic nonunion of TTA in 13 (65%), progression of symptomatic subtalar osteoarthritis (OA) in 4 (20%), and symptomatic nonunion of primary TTA combined progressively symptomatic subtalar OA in 2 (10%). Preoperative radiographic subtalar OA severity and postoperative radiographic alignment were not correlated with subsequent STA. Diabetes mellitus, Charcot arthropathy, neuropathy, alcohol use, substance use disorder, and psychiatric disease were significantly associated with having a subsequent STA. The most common postoperative contributing factor for subsequent STA following primary TTA was the salvage of symptomatic ankle nonunion rather than subtalar joint disease. Patients considering an ankle fusion should be counseled of the risk of subsequent STA, especially if they have risk factors that include diabetes, Charcot arthropathy, neuropathy, alcohol use, substance use disorder, or psychiatric disease.
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Affiliation(s)
- Song Ho Chang
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Boston, USA; Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Japan; Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
| | - Noortje C Hagemeijer
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Boston, USA; Department of Orthopedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Jirawat Saengsin
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Boston, USA; Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Escar Kusema
- Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Boston, USA
| | - Brandon L Morris
- Massachusetts General Hospital and Newton-Wellesley Hospital, Harvard Medical School, Boston, MA; Newton-Wellesley Hospital, Newton, MA
| | - Christopher W DiGiovanni
- Massachusetts General Hospital and Newton-Wellesley Hospital, Harvard Medical School, Boston, MA; Newton-Wellesley Hospital, Newton, MA
| | - Daniel Guss
- Massachusetts General Hospital and Newton-Wellesley Hospital, Harvard Medical School, Boston, MA; Newton-Wellesley Hospital, Newton, MA
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Wallace GF. Current Orthobiologics for Elective Arthrodesis and Nonunions of the Foot and Ankle. Clin Podiatr Med Surg 2017; 34:399-408. [PMID: 28576198 DOI: 10.1016/j.cpm.2017.02.010] [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: 01/17/2023]
Abstract
A fusion rate of 100% would be ideal. Despite adhering to sound surgical principles, complete compliance, and no adverse comorbidities, that 100% fusion rate goal is elusive. Orthobiologics are a special class of materials developed to enhance the fusion rates in foot and ankle arthrodesis sites. Whether orthobiologics are used for the first fusion or reserved for a nonunion is debatable, especially when considering cost.
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Affiliation(s)
- George F Wallace
- Podiatry Service, Ambulatory Care Services, University Hospital, 150 Bergen Street G-142, Newark, NJ 07103, USA.
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