Mid- to long-term outcome of 96 corrective hindfoot fusions in 84 patients with rigid flatfoot deformity

Abstract

Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction. The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus. A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively. In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10). In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.

Comparative Study of Spring Ligament Reconstructions Using Either Hamstring Allograft or Synthetic Ligament Augmentation

“…1,11,15,20,23,[34][35][36] Complication rates are higher 16,18,25,27,32,[39][40][41][42][43][44][45][46][47][48][49] and carry additional risks to joint-preserving procedures such as nonunion, avascular necrosis, and increased incidence of secondary arthritis. 33,34,42 Subsequently, joint preservation surgery has become increasingly explored. 45 Often this includes a calcaneal osteotomy to offload the spring ligament complex and transfer of the FDL to compensate for PTT dysfunction.…”

Outcomes of Reconstruction of the Stage II Adult-Acquired Flatfoot Deformity in Older Patients

“…Röhm et al 16 in a study of 96 hindfoot fusions in 84 patients (average age, 66 years; range, 35-85 years) with stage III rigid flatfoot found that the most common complication was nonunion in 11 feet (11.6%), of which 6 feet needed a revision. 16 They reported that 14 feet (14.7% of patients) required a secondary surgery as a result of complications including nonunion, avascular necrosis, progression of flatfoot deformity, and arthritis. 18 Therefore, fusion in the flatfoot population is not without risks.…”

“…9 The use of a triple arthrodesis in the flatfoot population is also associated with complications. Röhm et al 16 in a study of 96 hindfoot fusions in 84 patients (average age, 66 Patients in the older group had low rates of undergoing subsequent procedures. Their rates of flatfoot revisions (P = .75), arthrodeses (P = .38), and removals of hardware (P = .12) were not significantly different than those of patients in younger cohorts.…”

Adult Acguired Flatfoot Deformity (Review)

“…этот способ позволяет добиться хорошей коррекции, поэтому на се-годняшний день во многих ортопедических центрах используют эту методику. J. Röhm с со-авторами представили результаты лечения 84 пациентов (96 стоп) с ригидными плоско-валь-гусными деформациями, которым был выпол-нен двухсуставной артродез из одного медиаль-ного доступа [67]. Средний возраст пациентов составлял 66 лет, средний отдаленный резуль-тат -4,7 года.…”