Is Subtalar Joint Cartilage Resection Necessary for Tibiotalocalcaneal Arthrodesis via Intramedullary Nail? A Multicenter Evaluation

Abstract Tibiotalocalcaneal arthrodesis with intramedullary nailing is traditionally performed with formal preparation of both the subtalar and ankle joints. However, we believe that subtalar joint preparation is not necessary to achieve satisfactory outcomes in patients undergoing tibiotalocalcanea...

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Bibliographic Details
Published in:The Journal of foot and ankle surgery 2016-05, Vol.55 (3), p.572-577
Main Authors: Mulhern, Jennifer L., DPM, AACFAS, Protzman, Nicole M., MS, Levene, Maxwell J., DPM, AACFAS, Martin, Scott M., DPM, Fleming, Justin J., DPM, FACFAS, Clements, J. Randolph, DPM, FACFAS, Brigido, Stephen A., DPM, FACFAS
Format: Article
Language:English
Subjects:
Aged
Ankle Joint - physiopathology
Ankle Joint - surgery
arthrodesis
Arthrodesis - instrumentation
Arthrodesis - methods
Cartilage, Articular - surgery
Cohort Studies
end-stage osteoarthritis
Female
Follow-Up Studies
Fracture Fixation, Intramedullary - methods
Humans
intramedullary nail
Male
Middle Aged
Orthopedics
Pain Measurement
pantalar
Radiography - methods
Recovery of Function
Retrospective Studies
Risk Assessment
subtalar joint
Subtalar Joint - diagnostic imaging
Subtalar Joint - surgery
Treatment Outcome
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Summary:Abstract Tibiotalocalcaneal arthrodesis with intramedullary nailing is traditionally performed with formal preparation of both the subtalar and ankle joints. However, we believe that subtalar joint preparation is not necessary to achieve satisfactory outcomes in patients undergoing tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. The primary aim of the present retrospective study was to evaluate the outcomes of patients who had undergone tibiotalocalcaneal arthrodesis with an intramedullary nail without formal subtalar joint cartilage resection. A multicenter medical record review was performed to identify consecutive patients. Pain was assessed using a visual analog scale, and osseous union at the tibiotalar joint was defined as bony trabeculation across the arthrodesis site on all 3 radiographic views. Progression of joint deterioration was evaluated across time at the subtalar joint, using a modified grading system developed by Takakura et al. Forty consecutive patients (aged 61.9 ± 12.9 years; 17 men) met the inclusion and exclusion criteria. Compared with the pain reported preoperatively (6.4 ± 2.7), a statistically significant decline was seen in the pain experienced after surgery (1.2 ± 1.8; p  
ISSN:1067-2516
1542-2224
DOI:10.1053/j.jfas.2015.11.007