Isolated Subtalar Arthrodesis*

Easley, Mark E.; Trnka, Hans-Jörg; Schon, Lew C.; Myerson, Mark S.

doi:10.2106/00004623-200005000-00002

Cited by 378 publications

(377 citation statements)

References 21 publications

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“…More investigation is necessary to determine if rhBMP-2 has a role in hindfoot and ankle fusion surgery. Previous arthrodesis of the adjacent joint is a risk factor for nonunion of the tibiotalar joint (with a previously fused subtalar joint) [7] or of the subtalar joint (with a previously fused tibiotalar joint) [12,26]. Easley et al [11], whose study included only patients who underwent revision arthrodesis, reported a union rate that was comparable to the rate in our patients.…”

Section: Discussionsupporting

confidence: 73%

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Gorman

Beals

Nickisch

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Previous hindfoot surgeries present a unique challenge to hindfoot arthrodesis, as the patients may have multiple incisions around the hindfoot. In high-risk patients with compromised soft tissues, a posterior approach can provide an alternative for a fresh soft tissue plane for the surgery. The use of a blade plate construct is widely accepted; however, there are limited data supporting the use of a posterior approach. Questions/purposes We asked (1) what proportion of patients treated with this technique achieved osseous union; (2) what complications were observed; (3) were any patient-demographic or health-related factors associated with the likelihood that a patient would have a complication develop? Methods Between December 2001 and July 2014, 42 patients received a posterior blade plate. During the period in question, indications for hindfoot arthrodesis using posterior blade fixation were subtalar osteoarthritis below an ankle fusion, malunion or nonunion, failed tibiotalocalcaneal arthrodesis attributable to nonunion of the tibiotalar and/or subtalar joint; or tibiotalar and subtalar osteoarthritis in patients with impaired bone or soft tissue quality (particularly if the soft tissue problem was anterior). During that period, all patients who met those indications were treated with a posterior blade plate. Forty (95%) were included in this study, and two were lost to followup before the 1-year minimum required by the study. Demographics (age, gender, BMI, smoking status, and comorbidities) and surgical data (indication, previous treatment, and additional procedures) were analyzed. Of the 40 patients included, 27 (68%) were male and 13 (33%) were female, with a median of two previous hindfoot or ankle surgeries (range, 0-9 surgeries). The mean age of the patients was 56 ± 13 years. Followup averaged 47 ± 28 months (range, 14-137

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Section: Discussionsupporting

confidence: 73%

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Gorman

Beals

Nickisch

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…To date, salvage procedures after talar malunions with joint involvement have consisted mainly of arthrodesis of the affected joints. Numerous studies have described ankle, subtalar and talonavicular, tibiotalocalcanear or triple arthodesis for posttraumatic arthritis, malunion, nonunion or AVN (Canale and Kelly 1978, Frawley et al 1995, Gagneux et al 1997, Kitaoka and Patzer 1998, Rockett et al 1998, Liener et al 1999, Asencio et al 2000, Chou et al 2000, Easley et al 2000. More recently, total ankle arthroplasty has become an alternative to ankle arthrodesis in cases in which only the ankle joint is affected (Hintermann and Valderrabano 2003).…”

Section: Discussionmentioning

confidence: 99%

Anatomical reconstruction of malunited talus fractures

et al. 2005

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“…Isolated subtalar arthrodesis is the preferred procedure in patients with clinical and radiographic arthritis confined to the subtalar joint that is refractory to conservative treatment [11,14,18,24]. Additive fusions of the talonavicular and calcaneocuboid joints, resulting in double [29] and triple arthrodeses [28,31], respectively, are done when arthritic joint changes, deformity and symptoms clearly extend to the midtarsal joints (Chopart's).…”

Section: Introductionmentioning

confidence: 99%

How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model

Hutchinson

Baxter

Gilbert

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background While successful subtalar joint arthrodesis provides pain relief, resultant alterations in ankle biomechanics need to be considered, as this procedure may predispose the remaining hindfoot and tibiotalar joint to accelerated degenerative changes. However, the biomechanical consequences of isolated subtalar joint arthrodesis and additive fusions of the Chopart's joints on tibiotalar joint biomechanics remain poorly understood. Questions/purposes We asked: What is the effect of isolated subtalar fusion and sequential Chopart's joint fusions of the talonavicular and calcaneocuboid joints on tibiotalar joint (1) mechanics and (2) kinematics during loading for neutral, inverted, and everted orientations of the foot? Methods We evaluated the total force, contact area, and the magnitude and distribution of the contact stress on the articular surface of the talar dome, while simultaneously tracking the position of the talus relative to the tibia during loading in seven fresh-frozen cadaver feet. Each foot was loaded in the unfused, intact control condition followed by three randomized simulated hindfoot arthrodesis modalities: subtalar, double (subtalar and talonavicular), and triple (subtalar, talonavicular, and calcaneocuboid) arthrodesis. The intact and arthrodesis conditions were tested in three alignments using a metallic wedge insert: neutral (flat), 10°i nverted, and 10°everted. Results Tibiotalar mechanics (total force and contact area) and kinematics (external rotation) differed owing to hindfoot arthrodeses. After subtalar arthrodesis, there were Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® decreases in total force (445 ± 142 N, 95% CI, 340-550 N, versus 588 ± 118 N, 95% CI, 500-676 N; p \ 0.001) and contact area (282 mm 2 , 95% CI, 222-342 mm 2 , versus 336 ± 96 mm 2 , 95% CI, 265-407 mm 2 ; p \ 0.026) detected during loading in the neutral position; these changes also were seen in the everted foot position. Hindfoot arthrodesis also was associated with increased external rotation of the tibiotalar joint during loading: subtalar arthrodesis in the neutral loading position (3.3°± 1.6°; 95% CI, 2°-4.6°; p = 0.004) and everted loading position (4.8°± 2.6°; 95% CI, 2.7°-6.8°; p = 0.043); double arthrodesis in neutral (4.4°± 2°; 95% CI, 2.8°-6°; p = 0.003) and inverted positions (5.8°± 2.6°; 95% CI, 3.7°-7.9°; p = 0.002), and triple arthrodesis in all loaded orientations including neutral (4.5°±1.8°; 95% CI, 3.1°-5.9°; p = 0.002), inverted (6.4°± 3.5°; 95% CI, 3.6°-9.2°; p = 0.009), and everted (3.6°± 2°; 95% CI, 2°-5.2°; p = 0.053) positions. Finally, after subtalar arthrodesis, additive fusions at Chopart's joints did not appear to result in additional observe...

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Isolated Subtalar Arthrodesis*

Cited by 378 publications

References 21 publications

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Anatomical reconstruction of malunited talus fractures

How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model

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