Midterm Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft

Abstract

Background: Tibiotalocalcaneal (TTC) arthrodesis implementing adjunctive allografts is a method of limb salvage for patients with complex hindfoot osseous deficits, though outcome results are limited. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: The authors reviewed 24 TTC arthrodesis procedures with bulk femoral head allografts performed by a single surgeon from 2004 to 2016. Radiographic union at the ankle and subtalar joints along with stability of the allograft were assessed. Patients who had clinically successful arthrodeses were contacted to score the Foot and Ankle Ability Measure—Activities of Daily Living (FAAM-ADL) questionnaire, Visual Analog Scale (VAS) for pain, and Short Form-12 (SF-12) at a mean of 58.0 months (range, 28-102) postoperatively. Results: Complete radiographic union of involved joints was achieved in 15 patients (63%) and in 75% (36/48) of all joints; 21 ankles (88%) were assessed to be radiographically stable at final follow-up. Three patients (13%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 21 patients (88%) did not require additional surgery as of final follow-up. Patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P < .001). The mean VAS for pain significantly improved from 77.2 to 32.9 (P < .001). Male sex (P = .08) and a lateral operative approach (P = .03) both resulted in worse outcomes. Conclusion: Use of a femoral head allograft with TTC arthrodesis can offer improved functional scores and sustained radiographic outcomes. Level of Evidence: Level IV: Case series

Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer

“…The same study also suggests that successful patient outcomes are possible without complete radiographic fusion. 16 …”

Salvage Tibiotalocalcaneal Arthrodesis Augmented With Fibular Columns and Iliac Crest Autograft: A Technical Note

“…There is a paucity of literature available regarding this technique, which reflects the difficulty in identifying suitable patients needing revision surgery with simultaneous subtalar degeneration and bone loss. Studies describing various techniques used to perform salvage TTC fusion generally involve small cohorts (between 10 and 25 patients) 8,16-19 ; therefore, it is difficult to draw conclusions about the success and complication rates of each technique. Only 3 studies have documented results of a similar salvage approach (21 patients overall), using the fibula as interposition graft.…”

“…Alternative spacers include allograft (distal tibia 16 or femoral head 18,19 ); however, the risk of disease transmission (albeit low), cost, and donor availability are still concerns. 20,21 Transplanted bone may have a role as osteoconductive graft as compared with autologous bone, which is osteoconductive, osteogenic, and osteoinductive.…”

Union of foot/ankle Arthrodesis: A Registry Study of Low-intensity Pulsed Ultrasound (LIPUS)

“…In the present study, union rates for foot/ankle arthrodesis with adjunctive LIPUS were found to be at least comparable to other therapies (Table 3). Others have reported lower union rates of 75% following IM nail use with allograft and additional adjunctive autograft [6]. Allograft has also been combined with demineralized bone matrix and iliac bone marrow aspirate during ankle and hindfoot arthrodesis with screw/plate [18].…”

“…The incidence of non-union following foot and ankle arthrodesis can reach as high as 36% [4].To aid in healing and reduce revision risk, bone grafts and growth factors are used as adjuncts to foot/ankle arthrodesis [5]. Surgical foot/ankle arthrodesis augmented with autograft and/or allograft have yielded union rates as low as 75% [6]. Several recombinant human platelet-derived growth factor-enriched bone grafts have also been approved for use in foot and ankle applications [7], but the clinical outcomes have been mixed.…”