Neurological deficits among risk factors for nonunion after tibiotalocalcaneal arthrodesis
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CHARLOTTE, N.C. — While tibiotalocalcaneal arthrodesis is effective for severe talar and subtalar joint disease the procedure has high nonunion rates, a speaker said, who noted prior neurological deficits as a risk factor for nonunion.
“Tibiotalocalcaneal (TTC) arthrodesis is used to treat a number of pathologies around the hind area of the foot for a variety of different conditions. Rates of nonunion have been reported to be as high as 20%. This can have significant morbidity for patients and can have significant financial impacts for health care systems,” Amiethab A. Aiyer, MD, said in his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting.
Aiyer and colleagues analyzed 428 abstracts and full-text articles from five databases for research on risk factors predictive of nonunion for TTC arthrodesis. Overall, eight studies that included a total of 607 patients and 33 potential risk factors were identified and used for meta-analysis.
Researchers found prior neurological deficits, such as Charcot neuroarthropathy and diabetes neuropathy, were associated with nonunion following surgery (odds ratio = 2.86). They also found moderate evidence for preoperative infection as a risk factor for nonunion (odds ratio = 3.99). Additionally, researchers noted that smoking and diabetes were not found to be significant risk factors in their meta-analysis; however, multiple high-quality studies have highlighted these comorbidities as risk factors for nonunion.
“These issues should be looked at carefully with regard to guiding your patient postoperatively after TTC arthrodesis,” Aiyer concluded.
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Patel SS, et al. Risk factors for nonunion following tibiotalocalcaneal arthrodesis: A systematic review and meta-analysis. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting. Sept. 22 - Sept. 25, 2021; Charlotte, N.C.
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