Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction

Abstract

BackgroundThe foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture.MethodsBetween 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery.ResultsThe mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years). The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain), six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case.ConclusionsEarly isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.

Isolated talonavicular joint arthrodesis through minimal incision surgery

“…Satisfactory outcomes from screw arthrodesis, non-angle-stable plates and memory staples have been reported [5,20]. In a recent report, Jarrell et al [4] compared the biomechanical properties of screw versus combined plate-and-screw fixation for talonavicular fusion.…”

“…Chen et al reported adjacent joint arthritic changes occurred in 5 of 16 feet (31%) [11]. Popelka et al [5] recorded the progression of deformities and changes in surrounding joints in two patients (3 and 6 years after the operation). However, other authors have pointed out that, if the foot is placed in a well-aligned position, excessive stress and the development of adjacent arthritis can be minimized [27].…”

“…It is currently being used to treat traumatic, rheumatoid, and degenerative isolated talonavicular arthritis, posterior tibial tendon deficiencies, and pes valgus deformities, as well as congenital deformities and neuromuscular diseases [1][2][3]5,[11][12][13][14][15][16][17][18]. We used isolated TNA by MIS, fundamentally for patients with precarious soft tissue, but without malalignment of the hindfoot or peritalar destabilization [19].…”

“…Isolated talonavicular arthrodesis (TNA) has demonstrated to provide satisfactory pain relief and to be an appropriate action to control progression in cases of flatfoot deformity [1][2][3]. In spite of the above, orthopedic surgeons are faced with a significant rate of osseous non-union after conventional surgery and screw or plate fixation [1,4,5]. Additionally, in many patients with indications for TNA, soft tissues are in a poor condition because of previous surgeries.…”

Arthrodesis of the talonavicular joint using angle-stable mini-plates: a prospective study

“…Review of the literature indicates that there are a large variety of osteosynthetic implants for the fusion of the talonavicular joint. Satisfactory outcome from screw arthrodesis [9], non angle-stable plates [10] and memory staples have been reported [11]. A recent report by Jarrell et al compared the biomechanical properties of screw versus combined plate and screw fixation for talonavicular fusion [12].…”