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Tibiotalocalcaneal arthrodesis, subtalar joint cartilage resection offer similar clinical outcomes

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LONG BEACH, Calif. — Tibiotalocalcaneal arthrodesis with intramedullary nailing without preparation of the subtalar joint offered clinical results similar to those produced with subtalar joint cartilage resection, resulting in decreased pain and a shorter duration of surgery, according to data presented at the American Orthopaedic Foot & Ankle Society Annual Meeting.

Justin Fleming, DPM, FACFAS and colleagues conducted a retrospective, multi-chart review of 20 patients (mean age: 66.3 years) who underwent tibiotalocalcaneal arthrodesis using intramedullary nailing without the formal preparation of subtalar joint surfaces. Average follow-up was 2.1 years. VAS was used to assess pain, and the researchers defined bony union at the tibio-talar joint as bony trabeculation observed in three radiographic views.

Justin Fleming

Findings showed a statistically significant decline in pain after the procedure (VAS: 1.9) compared with preoperative pain scores (VAS: 5.8). The average duration of surgery was 108.5 minutes, and time to bony union at the ankle joint was an average of 3.3 months. According to Fleming, there was one delayed union that eventually was united with the use of a bone simulator. The union rate was 100% after 6 months.

A majority of the patients received allografts, Fleming said during his presentation. Seventeen percent of patients received autografts, and in 32% of patients, no graft was used.

“We had two hardware failures, which represents 5% of the population,” Fleming said during his presentation. “One occurred in a post-anterior locking screw, and the second occurred at the rod at the level of the Taylor screw. Neither was required retrieval nor affected the patient outcome.” – by Monica Jaramillo

Reference:

Fleming J. Is subtalar joint cartilage resection necessary for tibiotalocalcaneal arthrodesis via intramedullary nail? A multi-center evaluation. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; July 15-18, 2015; Long Beach, Calif.

Disclosure: Fleming reports no relevant financial disclosures.