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Wong-Chung J, Blythe A, Lynch-Wong M, McKenna R, Wilson A, Stephens M. Outcomes of Selective Arthrodesis Based on Joints Affected in 33 Feet With Müller-Weiss Disease. J Foot Ankle Surg 2024; 63:199-206. [PMID: 38061622 DOI: 10.1053/j.jfas.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/19/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
No consensus exists regarding operative treatment of Müller-Weiss disease (MWD). Its only classification is based solely on Méary's angle and serves neither as guide to management nor prognosis. We report on 33 feet that underwent surgery following failed conservative management. Treatment was directed towards joint(s) involved, as determined by clinical examination, plain radiography and SPECT-CT. Thus, surgery consisted of isolated talonavicular in 6 feet, triple in 8, subtalar and talonavicular in 7, talonaviculocuneiform in 4, talonaviculocuneiform with interpositional tricortical iliac crest graft in 6 and pantalar arthrodesis in 2. PROMIS scores for pain interference and depression decreased significantly (p < .001) with significant accompanying increase in physical function (p = .003). Union occurred in 31 of 33 feet (94%) with complete resolution of pain at an average follow-up of 84 months. Of the 2 nonunions, 1 had fracture through the lateral navicular, and the other marked sclerosis and avascularity of the lateral navicular. We describe our pathways for selecting arthrodesis based on the joints affected. Isolated talonavicular arthrodesis was performed in early stages of MWD, which begins at the talonavicular articulation. When disease extended to both sides of the navicular, we performed talonaviculocuneiform arthrodesis. When considering isolated talonavicular, double medial or triple arthrodesis, there should be adequate cancellous bone stock remaining in the lateral part of the navicular, as determined on medial oblique radiographs and CT scan. In case of inadequate bone stock or fracture through the lateral navicular, talonaviculocuneiform arthrodesis with interpositional iliac crest bone graft is recommended.
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Affiliation(s)
- John Wong-Chung
- Department of Orthopaedics, Altnagelvin Hospital, Londonderry, Northern Ireland; Department of Orthopaedics, Musgrave Park Hospital, Belfast, Northern Ireland.
| | - Andrew Blythe
- Department of Orthopaedics, Altnagelvin Hospital, Londonderry, Northern Ireland
| | - Matthew Lynch-Wong
- Department of Orthopaedics, Altnagelvin Hospital, Londonderry, Northern Ireland
| | - Raymond McKenna
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, Northern Ireland
| | - Alistair Wilson
- Department of Orthopaedics, Musgrave Park Hospital, Belfast, Northern Ireland
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Yang Q, Shan C, Zhao B, Liu W, Hai J. The effect of early weight-bearing on bone fusion after triple arthrodesis. Comput Methods Biomech Biomed Engin 2024:1-11. [PMID: 38229421 DOI: 10.1080/10255842.2023.2293646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024]
Abstract
Triple arthrodesis is an effective method for treating stiff horseshoe feet and severe osteoarthritis. However, it is still a challenge to improve postoperative bone fusion by changing early weight-bearing. This study improved the classical bone remodeling algorithm, established a mathematical relationship between density change rate and mechanical stimulation, and combined it with finite element theory. The proposed algorithm can not only predict the effect of early weight-bearing on triple arthrodesis but also visually demonstrate the change of bone mineral density with time. The analysis results indicated that 2.5% of the initial load was a potential factor leading to bone nonunion, and 50% of the initial load would result in bone resorption. Meanwhile, it was found that 25% of the external load was more conducive to postoperative rehabilitation. The study results have theoretical significance for enhancing the effect of postoperative bone fusion and formulating a more scientific rehabilitation program, thereby supporting patients' postoperative rehabilitation exercise.
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Affiliation(s)
- Qingwei Yang
- School of Mechanical Engineering, Xinjiang University, Shuimogou District, Urumqi, Xinjiang, China
| | - Chunlong Shan
- Xinjiang Medical University, Shuimogou District, Urumqi, Xinjiang, China
| | - Bo Zhao
- Xinjiang Medical University, Shuimogou District, Urumqi, Xinjiang, China
| | - Wei Liu
- Xinjiang Medical University, Shuimogou District, Urumqi, Xinjiang, China
| | - Jizhe Hai
- School of Mechanical Engineering, Xinjiang University, Shuimogou District, Urumqi, Xinjiang, China
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Perkins JM, Vacketta VG, Prissel MA. Triple Arthrodesis: How to Manage Failures, Malunion, and Nonunion. Clin Podiatr Med Surg 2023; 40:649-668. [PMID: 37716743 DOI: 10.1016/j.cpm.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Nonunions are managed by general principles that govern other bone healing sites; however, when confounding with malunion, additional attention must be given. Malunited triple arthrodesis requires a thorough understanding of biomechanical and surgical principles for adequate revision surgery. Due to the rigid nature of arthrodesis surgery on a weight-bearing surface, malunited fusions have very low patient tolerance. The lack of joints leads to a block of bone that can be corrected via derotational osteotomies with wedge supplementation. However, even if a rectus foot is achieved, compensatory motion via the ankle joint commonly causes arthritic long-term sequelae.
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Affiliation(s)
- Jacob M Perkins
- Orthopedic Foot and Ankle Center Advanced Foot and Ankle Reconstruction Fellowship, 350 W. Wilson Bridge Road, Street. 200, Worthington, OH 43085, USA.
| | - Vincent G Vacketta
- Orthopedic Foot and Ankle Center Advanced Foot and Ankle Reconstruction Fellowship, 350 W. Wilson Bridge Road, Street. 200, Worthington, OH 43085, USA
| | - Mark A Prissel
- Advanced Foot and Ankle Reconstruction, Orthopedic Foot and Ankle Center, 350 W. Wilson Bridge Road, Street. 200, Worthington, OH 43085, USA
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Burns PR, Powers NS. Double versus Triple Arthrodesis for Flatfoot Deformity: When, Why, and How? Clin Podiatr Med Surg 2023; 40:315-332. [PMID: 36841582 DOI: 10.1016/j.cpm.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Different types of arthrodesis for flatfoot deformity have a long history in foot and ankle surgery. Arthrodesis of the rearfoot can be a useful tool in helping correct deformity and maintaining that correction with good long-term results. Questions have risen recently however about the necessity of including the calcaneocuboid joint in the traditional rearfoot arthrodesis or triple arthrodesis. The double arthrodesis of the talonavicular and subtalar joints has grown in popularity and this review helps the reader choose with a review of the biomechanics, surgical approaches, fixation techniques and recent literature outcomes of both procedures.
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Affiliation(s)
- Patrick R Burns
- University of Pittsburgh School of Medicine, University of Pittsburgh Physicians, Comprehensive Foot & Ankle Center, 1515 Locust Street #350, Pittsburgh, PA 15219, USA.
| | - Nicholas S Powers
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Maier F, Wiebking U, O'Loughlin PF, Krettek C, Gaulke R. Clinical and Radiological Mid- to Long-term Results Following Triple Arthrodesis. In Vivo 2023; 37:714-725. [PMID: 36881076 PMCID: PMC10026657 DOI: 10.21873/invivo.13133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/22/2023] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Triple arthrodesis (TA) is a common procedure for stabilization of painful and unstable hind foot deformities. The aim of the study was to analyze postoperative changes in function and pain following isolated TA based on clinical outcomes, radiological findings, and pain scores. The study also considered economic aspects, such as the inability to work, before and after surgery. PATIENTS AND METHODS This was a single-center retrospective study, with a mean follow-up of 7.8 (range=2.9-12.6) years, of isolated triple fusions was performed. Short-Form 36 (SF-36), Foot Function Index (FFI), American Orthopedic Foot and Ankle Society Score (AOFAS) were analyzed. Clinical examination and standardized radiographs pre- and post-surgery were evaluated. RESULTS All 16 patients were very satisfied with the outcome after TA. In patients with secondary arthrosis of the ankle joint, AOFAS scores were significantly lower (p=0.012), whereas arthrosis in tarsal and tarsometatarsal joints did not affect the score. Body mass index (BMI) was associated with lower AOFAS, FFI-pain, FFI-function and increased hindfoot valgus. The non-union rate was approximately 11%. CONCLUSION TA leads to good clinical and radiological outcomes. None of the study participants reported a deterioration in their quality of life after TA. Two thirds of the patients reported significant limitations when walking on uneven ground. More than half of the feet developed secondary arthrosis of the tarsal joints and 44% of the ankle joint.
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Affiliation(s)
- Ferdinand Maier
- Hannover Medical School, Department of Trauma Surgery, Hannover, Germany
| | - Ulrich Wiebking
- Hannover Medical School, Orthopedic Clinic in the DIAKOVERE Annastift, Hannover, Germany
| | | | - Christian Krettek
- Hannover Medical School, Department of Trauma Surgery, Hannover, Germany
| | - Ralph Gaulke
- Hannover Medical School, Department of Trauma Surgery, Hannover, Germany;
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Matsumoto T, Takeda R, Uchio A, Mizuhara H, Omata Y, Juji T, Tanaka S. Associated correction of forefoot alignment with hindfoot fusion for pes planovalgus deformity. Foot Ankle Surg 2023; 29:280-287. [PMID: 36870925 DOI: 10.1016/j.fas.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/31/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The present study aimed to investigate changes in hallux alignment after corrective surgery for adult-acquired flatfoot deformity (AAFD). PATIENTS AND METHODS The present study retrospectively investigated the changes of hallux alignment in 37 feet (33 patients) which were treated with double or triple arthrodesis of the hindfoot for AAFD between 2015 and 2021 and could be followed up to one year postoperatively. RESULTS Hallux valgus (HV) angle significantly decreased by a mean 4.1° among the whole 37 subjects and by a mean 6.6° among the 24 subjects who had a preoperative HV angle of 15° or more. Those who had HV correction (HV angle correction ≥ 5°) demonstrated more near-normal postoperative alignment of the medial longitudinal arch and hindfoot than those without HV correction. CONCLUSIONS Hindfoot fusion for AAFD could improve preoperative HV deformity to some degree. HV correction was associated with proper realignment of the midfoot and hindfoot. LEVEL OF EVIDENCE Level IV; retrospective case series.
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Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Rheumatology, JCHO Yugawara Hospital, 2-21-6 Chuo, Yugawara, Ashigara-shimo, Kanagawa 259-0396, Japan.
| | - Ryutaro Takeda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akihiro Uchio
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyasu Mizuhara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasunori Omata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takuo Juji
- Department of Rheumatology, JCHO Yugawara Hospital, 2-21-6 Chuo, Yugawara, Ashigara-shimo, Kanagawa 259-0396, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Liu W, Li F, He H, Teraili A, Wang X, Wahapu P, Wang C. Biomechanical application of finite elements in the orthopedics of stiff clubfoot. BMC Musculoskelet Disord 2022; 23:1112. [PMID: 36544111 PMCID: PMC9768888 DOI: 10.1186/s12891-022-06092-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of varying the different correction angles of hindfoot osteotomy orthosis on the biomechanical changes of the adjacent joints after triple arthrodesis in adult patients with stiff clubfoot to determine the optimal hindfoot correction angle and provide a biomechanical basis for the correction of hindfoot deformity in patients with stiff clubfoot. METHODS A 26-year-old male patient with a stiff left clubfoot was selected for the study, and his ankle and foot were scanned using dual-source computed tomography. A three-dimensional finite element model of the ankle was established, and after the validity of the model was verified by plantar pressure experiments, triple arthrodesis was simulated to analyze the biomechanical changes of the adjacent joints under the same load with "3°" of posterior varus, "0°" of a neutral position and "3°, 6°, 9°" of valgus as the correction angles. RESULTS The peak plantar pressure calculated by the finite element model of the clubfoot was in good agreement with the actual plantar pressure measurements, with an error of less than 1%. In triple arthrodesis, the peak von Mises stress in the adjacent articular cartilage was significantly different and less than the preoperative stress when the corrected angle of the hindfoot was valgus "6°". In comparison, the peak von Mises stress in the adjacent articular cartilage was not significantly different in varus "3°", neutral "0°", valgus "3°" and valgus "9°" compared with the preoperative stress. CONCLUSION The results of this study showed that different angles of hindfoot correction in triple arthrodesis did not increase the peak von Mises stress in the adjacent joints, which may not lead to the development of arthritis in the adjacent joint, and a hindfoot correction angle of "6°" of valgus significantly reduced the peak von Mises stress in the adjacent joints after triple arthrodesis.
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Affiliation(s)
- Wei Liu
- grid.459346.90000 0004 1758 0312The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Fei Li
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Haiyang He
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Aihelamu Teraili
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Xue Wang
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Paerhati Wahapu
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Chengwei Wang
- grid.459346.90000 0004 1758 0312The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
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Madi NS, Fletcher AN, Easley ME. Double and Triple Tarsal Fusions in the Severe Rigid Flatfoot Deformity. Foot Ankle Clin 2022; 27:805-818. [PMID: 36368798 DOI: 10.1016/j.fcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A flatfoot deformity is a multiplanar foot deformity characterized by forefoot abduction and supination and hindfoot valgus. With progressive pathology, a rigid deformity may develop. In the setting of a rigid deformity, the appropriate procedure to use is not without controversy. The extent of joints to involve in the arthrodesis depends on the ability to obtain a plantigrade foot. Both double and triple arthrodesis have been suggested. Care must be taken to avoid lateral column shortening and loss of foot reduction when fusing the CC joint. The concerns about lateral skin breakdown led some surgeons to describe a single medial incision for a triple or modified double arthrodesis. The necessity of bone grafting has been controversial. Implant selection is essential to achieve solid stabilization of the arthrodesis sites. To decrease the risk of overcorrection and malunion, the surgeon should be familiar with the hindfoot biomechanics and generate, based on the clinical examination and imaging, a meticulous preoperative plan to address and balance both the soft tissue and bony deformity.
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Affiliation(s)
- Naji S Madi
- Foot & Ankle Surgery, Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV, USA.
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Andrews NA, Patch DA, Torrez TW, Sutherland CR, Harrelson WM, Pitts C, Agarwal A, Shah A. Which surgical approach is optimal for joint preparation in talonavicular fusion - A cadaver study. Foot Ankle Surg 2022; 28:657-662. [PMID: 34420873 DOI: 10.1016/j.fas.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fusion of the talonavicular joint has proven challenging in literature. The optimal surgical approach for talonavicular arthrodesis is still uncertain. This study compares the amount of physical joint preparation between dorsal and medial approaches to the talonavicular joint. METHODS Twenty fresh frozen cadaver specimens were randomly assigned to receive either a dorsal or medial operative approach to the talonavicular joint. The joint surface was prepared, and the joint was disarticulated. Image analysis, using ImageJ, was performed by two blinded reviewers to assess the joint surface preparation and this was compared by surgical approach. RESULTS The dorsal approach had a higher median percentage of talar and total talonavicular joint surface area prepared (75% vs. 59% (p = .007) and 82% vs. 70% (p = .005)). Irrespective of approach, the talus was significantly more difficult to prepare than the navicular (62% vs 88% (p = .001)). CONCLUSION The dorsal approach provides superior talonavicular joint preparation. The lateral ¼th of the talar head was the most difficult surface to prepare, and surgeons performing double or triple arthrodesis may prepare the lateral talar head from the lateral approach. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Timothy W Torrez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Charles R Sutherland
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Charles Pitts
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Abhinav Agarwal
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
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Myerson MS, Haje DP. An Approach to the Management of Severe Clubfoot Deformities on Global Humanitarian Programs: The Role of Talectomy. Foot Ankle Clin 2021; 26:727-745. [PMID: 34752236 DOI: 10.1016/j.fcl.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The approach to treatment of severe untreated or recurrent congenital talipes equinovarus deformities is very different in the world where patients are mobile, have access to repeated return visits for follow-up treatment, and where more sophisticated options for gradual correction with external fixation are available. For treatment, talectomy may be the only option to treat certain neglected clubfoot deformities during humanitarian programs and it may still have to be used as a salvage procedure used in modern foot surgery. Our extensive experience with these deformities has been on global humanitarian programs.
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Affiliation(s)
| | - Davi P Haje
- Centro Clinico Orthopectus e IGESDF, SMHN Bloco A Ed. Clínicas, Sala 804-806, Brasília, DF 70710-904, Brazil
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Coleman MM, Guyton GP. Is Arthrodesis Sufficient in the Setting of Complex, Severe and Rigid Progressive Collapsing Foot Deformities? Foot Ankle Clin 2021; 26:609-617. [PMID: 34332738 DOI: 10.1016/j.fcl.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arthrodesis of the hindfoot is typically used for the correction of severe and arthritic progressive collapsing foot deformity. Concomitant bony or soft tissue procedures may be helpful in patients with congenital abnormalities including the ball-and-socket ankle or congenital vertical talus. Dysplasia of the hindfoot bones may be more common than previously recognized, and corrective procedures or alterations in technique may need to be performed during hindfoot arthrodesis to account for bony deformity. Intraarticular osteotomies, extraarticular osteotomies, tendon lengthening, and tendon transfer procedures may be used in specific instances to aid in deformity correction and improve overall function.
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Affiliation(s)
- Michelle M Coleman
- Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA.
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12
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Mortenson KE, Fallat LM. Principles of Triple Arthrodesis and Limited Arthrodesis in the Cavus Foot. Clin Podiatr Med Surg 2021; 38:411-425. [PMID: 34053652 DOI: 10.1016/j.cpm.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cavus foot is a complex podiatric deformity that requires precise and in-depth work-up through an objective, physical, and radiographic examination. The goal of surgical treatment is to eliminate pain while establishing a plantigrade foot structure. Triple arthrodesis has proven to be an effective surgical procedure for treatment of moderate to severe rearfoot deformity with or without the presence of rearfoot arthritic changes. The foot and ankle surgeon must always be aware that no two cavus deformity cases are alike, therefore one may require additional surgical procedures including soft tissue balancing, joint-sparing osteotomies, and/or supplementary arthrodesing procedures.
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Affiliation(s)
- Kalli E Mortenson
- Beaumont Health Wayne Podiatric Foot and Ankle Surgical Residency, Beaumont Hospital Wayne, 31555 Annapolis Street, Wayne, MI 48184, USA
| | - Lawrence M Fallat
- Beaumont Health Wayne Podiatric Foot and Ankle Surgical Residency, Beaumont Hospital Wayne, 31555 Annapolis Street, Wayne, MI 48184, USA.
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Abstract
This article discusses rearfoot fusions for foot and ankle surgeons. It establishes normal foot and ankle function primarily in the stance phase of gait. The foot is greatly affected by external and internal forces, which contribute to normal function or the need for compensatory mechanisms. As a result of compensation, many symptoms develop, often leading to debilitating disorders such as degenerative joint disease. The interaction of the ankle, subtalar, and midtarsal joints are outlined. Congenital deformities, trauma and abnormal compensation are reviewed along with corresponding sequelae. Surgery is often indicated to reduce symptoms, improve position, and help stabilize the foot.
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Affiliation(s)
- Harold D Schoenhaus
- Penn Presbyterian Medical Center, Philadelphia, PA, USA; Temple University School of Podiatric Medicine, Philadelphia, PA, USA.
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14
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Klerken T, Kosse NM, Aarts CAM, Louwerens JWK. Long-term results after triple arthrodesis: Influence of alignment on ankle osteoarthritis and clinical outcome. Foot Ankle Surg 2019; 25:247-250. [PMID: 29409183 DOI: 10.1016/j.fas.2017.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/15/2017] [Accepted: 11/19/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pain, deformity and instability are the main reasons for fusion of the tarsal joints, a triple arthrodesis. The short and midterm results show that mobility, function and satisfaction increase postoperatively. However, osteoarthritis (OA) of the adjacent ankle joint is described as a long-term complication. Alignment of the foot could be an influencing factor. The aim of this study was to examine whether malalignment after triple arthrodesis leads to a higher grade of OA at long-term follow-up. METHODS Between 1991 and 2002, 81 patients underwent a triple arthrodesis. Preoperatively, postoperatively, 3, 7.5 and 15 years after surgery, dorsoplantar (DP) and lateral X-rays were taken and used to evaluate the degree of OA and the geometry of the foot. The degree of OA was estimated using the Kellgren and Lawrence score. The geometry of the foot was assessed using Meary's angle; a Meary's angle exceeding 15° in DP and/or greater than -5 to 5° from the lateral view was defined as malalignment. In addition to the radiological evaluation, clinical scores (FFI and AOFAS) were recorded. RESULTS Thirty-five patients (40 feet) were available for analysis 15 years after surgery. In 19 cases there was an increase in ankle OA following the operation. Eight feet showed malalignment on the lateral view and 28 on the DP view. There was no difference in both an increase of ankle OA or clinical outcome between correct aligned feet and feet classified as malaligned. Thirty-three patients with 38 treated feet stated that they would decide to undergo the treatment again. Two patients would not want to undergo the same surgery again. The patients were satisfied with the result of surgery, clinical scores improved after surgery and remained stable in the long-term. CONCLUSIONS Triple arthrodesis is a salvage procedure in patients with a painful and deformed hindfoot and results in a clinically beneficial outcome, even 15 years after surgery. The present study did not show that malalignment after triple arthrodesis results in a higher grade of OA of the ankle joint in the long-term. The cause of the aggravation of OA is still not fully understood and needs further research. Nevertheless, clinical results are satisfying 15 years postoperatively.
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Affiliation(s)
- Tina Klerken
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Nienke M Kosse
- Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Chris A M Aarts
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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Abstract
Malunion remains a common complication after triple arthrodesis, with rates as high as 6% in the reported literature. Careful patient evaluation is critical to determine the location and degree of bony deformity. A stepwise systematic approach to correct hindfoot and midfoot deformity is presented in this article. Few studies have been published to guide foot and ankle surgeons with this difficult clinical scenario, but reports have demonstrated high success rates and low rates of complications after revision triple arthrodesis.
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16
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Abstract
In symptomatic patients, undercorrection of a flatfoot deformity can lead to the need for revision surgery to restore functional mechanics and prevent progression of deformity. The underlying cause of undercorrection is failure to fully recognize or understand the extent of the deformity. This article discusses the typical deformities in adult flatfoot and indications for surgical intervention. Also presented are the surgical procedures for the correction of the typical deformity patterns with available outcome statistics and a stepwise algorithm for patient evaluation to assist in treatment and mitigate the risk of undercorrection of deformity.
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17
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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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18
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Ohly NE, Cowie JG, Breusch SJ. Triple arthrodesis of the foot with allograft through a lateral incision in planovalgus deformity. Foot Ankle Surg 2016; 22:114-9. [PMID: 27301731 DOI: 10.1016/j.fas.2015.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/30/2015] [Accepted: 05/25/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Triple arthrodesis may be performed using various surgical approaches, most typically through two incisions and without structural bone graft. We have found that a single lateral incision allows adequate surgical exposure and structural bone graft facilitates lateral column reconstruction. METHODS A consecutive series of 30 triple arthrodeses with additive bone graft using a single lateral incision. Outcome measures were SF12 score, Manchester-Oxford Foot Questionnaire index score, visual analogue pain score and satisfaction scores, and radiographic assessment at 3, 6 and 12 months post-operatively. RESULTS Statistically significant improvements were seen in all measured outcomes, except the SF12 mental component score. The union rate was 100% with no loss of correction at 12 months. Twenty-nine out of 30 patients were satisfied. CONCLUSIONS In this series, triple arthrodesis using structural allograft through a single lateral incision was safe and effective, with restoration and maintenance of surgical deformity correction and foot length.
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Affiliation(s)
- Nicholas E Ohly
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
| | - Jonathan G Cowie
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
| | - Steffen J Breusch
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
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19
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Wicks ED, Morscher MA, Newton M, Steiner RP, Weiner DS. Partial or non-union after triple arthrodesis in children: does it really matter? J Child Orthop 2016; 10:119-25. [PMID: 27039315 PMCID: PMC4837165 DOI: 10.1007/s11832-016-0730-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Triple arthrodesis is a commonly performed salvage procedure to correct hindfoot deformity. Non-union is considered an undesirable radiographic outcome; however, the clinical ramifications of this are not as well defined. The purpose of this study was to determine the incidence of partial or complete radiographic non-union after triple arthrodesis in children and characterize the clinical consequences. METHODS An IRB-approved retrospective review of triple arthrodesis surgeries in patients less than 16 years of age performed by a single surgeon (DSW) identified 159 cases meeting the inclusion criteria. Plain radiographs were reviewed for bony fusion (defined as over 80 % radiographic bony union of the subtalar, calcaneocuboid, and talonavicular bones) and charts for clinical outcomes (pain, return to activity, and subsequent hindfoot surgeries). Statistics were used to compare the fused and unfused cases, with p < 0.05 considered to be significant. RESULTS Of the 159 cases included in the study, 9 % did not achieve at least 80 % plain film radiographic union. The fused and unfused groups had similar clinical outcomes. Only one patient required surgery for sequelae of symptoms arising from a pseudoarthrosis related to the triple arthrodesis. The fused and unfused groups were similar in terms of gender and pin removal time, but differed significantly in surgical age and underlying diagnosis. CONCLUSIONS This is one of the largest case series of pediatric triple arthrodesis surgery presented in the literature. This study demonstrated that good clinical outcomes can be achieved despite the lack of radiographic union after triple arthrodesis surgery in children. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Eric D Wicks
- Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | | | | | - Richard P Steiner
- Department of Statistics, University of Akron, Akron, OH, 44325, USA
| | - Dennis S Weiner
- Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
- Department of Pediatric Orthopaedic Surgery, Akron Children's Hospital, Akron, OH, USA.
- Regional Skeletal Dysplasia Clinic, Akron Children's Hospital, Akron, OH, 44302, USA.
- Akron Children's Hospital, 300 Locust Street, Ste. 250, Akron, OH, 44302-1821, USA.
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20
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Abstract
The medial approach to the subtalar joint allows good visualization of the articular surfaces. Compared with the lateral approach, advantages are found particularly in flatfoot correction, in which the single-incision technique can be used for corrective fusions of rigid flatfoot deformity. Union rates are comparable with the traditional lateral approach; however, wound healing problems occur less frequently. Avascular necrosis of the talus is a rare but serious complication, although frequency seems to be independent of the approach chosen. Clinical studies showed no increased morbidity when comparing the medial to the lateral approach.
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Affiliation(s)
- Markus Knupp
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland.
| | - Lukas Zwicky
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Tamara Horn Lang
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Julian Röhm
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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21
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Natsakis T, Burg J, Dereymaeker G, Jonkers I, Vander Sloten J. Inertial control as novel technique for in vitro gait simulations. J Biomech 2015; 48:392-5. [PMID: 25498365 DOI: 10.1016/j.jbiomech.2014.11.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 11/25/2022]
Abstract
In vitro gait simulations are a preferential platform to study new intervention techniques or surgical procedures as they allow studying the isolated effect of surgical interventions. Commonly, simulations are performed by applying pre-defined setpoints for the kinetics and kinematics on all degrees of freedom (DOFs) of the cadaveric specimen. This however limits the applicability of the experiment to simulations for which pre-defined kinematics and kinetics can be measured in vivo. In this study we introduce inertial control as a new methodology for gait simulations that omits the need for pre-defined setpoints for the externally applied vertical ground reaction force (vGRF) and therefore allows the effect of interventions to be reflected upon it. Gait simulations of stance (1 s) were performed in 10 cadaveric specimens under three clinically relevant conditions: native ankle, total ankle prosthesis (TAP) and total ankle prosthesis plus triple arthrodesis (TAP+TA). In the native ankle, simulated vGRF was compared against the vGRF measured in vivo in 15 healthy volunteers and high correlations were found (R(2)=0.956, slope of regression line S=1.004). In TAP and TAP+TA, vGRF changed, therefore confirming the sensitivity of the method to kinematic constrains imposed with surgery. Inertial control can replicate in vivo kinetic conditions and allows investigating the isolated effect of surgical interventions on kinematic as well as kinetics.
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Affiliation(s)
- T Natsakis
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300c, Box 2419, 2001 Heverlee, Belgium
| | - J Burg
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300c, Box 2419, 2001 Heverlee, Belgium; KU Leuven, Faculty of Kinesiology and Rehabilitation Science, Tervuursevest 101, Box 1500, 3001 Heverlee, Belgium
| | - G Dereymaeker
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300c, Box 2419, 2001 Heverlee, Belgium
| | - I Jonkers
- KU Leuven, Faculty of Kinesiology and Rehabilitation Science, Tervuursevest 101, Box 1500, 3001 Heverlee, Belgium
| | - J Vander Sloten
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300c, Box 2419, 2001 Heverlee, Belgium
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22
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Abstract
Triple arthrodesis is a powerful corrector of hindfoot deformity related to trauma, rheumatoid arthritis, and long-standing peritalar subluxation with posterior tibial tendon dysfunction. To avoid the common postoperative complications related to triple arthrodesis, one must be meticulous in preoperative evaluation as well as surgical technique. Presented are some tips and tricks to avoid the common complications and provide the patient with a plantigrade, stable foot, as well as some salvage options for triple arthrodesis in a malunited position.
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Affiliation(s)
- Nathan J Kiewiet
- Drisko, Fee & Parkins Orthopaedics, PC, 19550 East 39th Street, Suite 410, Independence, MO 64057, USA
| | - Stephen K Benirschke
- Department of Orthopaedics, University of Washington, 325 9th Avenue, Box 359798, Seattle, WA 98104, USA
| | - Michael E Brage
- Department of Orthopaedics, University of Washington, 325 9th Avenue, Box 359798, Seattle, WA 98104, USA.
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23
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Abstract
The primary goal of triple arthrodesis for stage III and IV adult acquired flatfoot is to obtain a well-aligned plantigrade foot that will support the ankle in optimal alignment. Ancillary procedures including posterior muscle group lengthening, medial displacement calcaneal osteotomy, medial column stabilization, peroneus brevis tenotomy, or transfer and harvest of regional bone graft are often necessary to achieve adequate realignment. Image intensification is helpful in confirming optimal realignment before fixation. Results of triple arthrodesis are enhanced with adequate preparation of joint surfaces, bone graft/orthobiologics, 2-point fixation of all 3 tritarsal joints, and a vertical heel position.
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Affiliation(s)
- Alan R Catanzariti
- Division of Foot & Ankle Surgery, West Penn Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
| | - Brian T Dix
- Division of Foot & Ankle Surgery, West Penn Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
| | - Phillip E Richardson
- Division of Foot & Ankle Surgery, West Penn Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
| | - Robert W Mendicino
- OhioHealth Orthopedic Surgeons, Hilliard, OH, USA; Foot & Ankle Surgical Residency, West Penn Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Abstract
The cavus, or high-arched, foot can present in either childhood or adulthood as a function of muscle imbalance. Neurologic, traumatic, and idiopathic processes have been identified, along with residual clubfoot, as the primary causes of adult cavus foot deformity. A thorough history and physical examination is important and can help identify the underlying cause of deformity. Conservative treatment modalities are always used first, with surgical intervention reserved for refractory cases. The goal of surgery is to correct muscle imbalance, which can be achieved via tendon transfers, corrective osteotomies, and, in the most severe cases, fusion.
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Affiliation(s)
- Andrew J Rosenbaum
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY 12208, USA.
| | - Jordan Lisella
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY 12208, USA
| | - Nilay Patel
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY 12208, USA
| | - Nani Phillips
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY 12208, USA
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