Calcaneal Osteotomies in Prevention of Deformity-Driven Subtalar Joint Arthritis

Abstract

Category: Hindfoot Introduction/Purpose: Calcaneal osteotomies (CO) have been described thoroughly in reduction of hindfoot and global deformities of the foot and ankle. Their ability to alter the ground reactive forces and abnormal joint motion in various deformities, realigning the mechanical axes to a more normal alignment has been well-described in the literature. Despite the high volume of studies involving calcaneal osteotomies in the correction of hindfoot deformities, few have investigated the protective nature of them in the prevention of end-stage osteoarthritis of the subtalar joint. The purpose of the present study was to identify the preventative nature of calcaneal osteotomies in the prevention of deformity-driven subtalar joint arthritis. Methods: 255 patients who underwent various calcaneal osteotomies (medial calcaneal displacement, lateral column lengthening, Dwyer) in a 2-year span were reviewed. Minimum of 3 years of follow up was required for the present study, and patient charts were reviewed to see if any went on to subtalar joint fusion secondary to deformity-driven osteoarthritis. Charts were also evaluated for hardware removal and nonunion rates, while lateral radiographs were evaluated for preoperative and long-term postoperative arthritis based on the Kellgren-Lawrence scale. Results: After inclusion criteria was applied, 44 patients were ultimately included in the study with an average follow up time of 51.8 months. In the end, 2.3% of patients underwent subtalar joint arthrodesis for treatment of deformity-driven osteoarthritis (1/44). Hardware removal and nonunion rates were 25% (11/44) and 2.3% (1/44), respectively. Kellgren-Lawrence evaluation showed there was some protective nature of CO's in prevention of subtalar joint arthritis, but the inter-observer coefficient was fair between two observers. ICC was fair for preoperative Kelgren Lawrence scores between the two presenters (ICC = 0.664), and poor for postoperative Kelgren Lawrence scores (ICC = 0.459). Conclusion: This is one of the only studies to evaluate the protective nature of calcaneal osteotomies in the prevention of deformity-driven subtalar joint arthritis. Clinical evaluation of this group suggested there is some protective nature in calcaneal osteotomies in the prevention of subtalar joint arthritis requiring arthrodesis, supporting the use of these osteotomies in the correction of hindfoot deformities. While the identified KG scores were not consistent between the two presenters, this is consistent with previous studies who investigated KG in the subtalar joint.