Hindfoot Double Arthrodesis in Adults Using Cannulated Screws: How We Do It?

Abstract

Hindfoot arthrodesis is a common orthopedic surgical procedure indicated for reconstructive surgery in patients with advanced osteoarthritis, rheumatoid arthritis, posterior tibial tendon insufficiency (stages III and IV), severe cases of tarsal coalition, advanced stages of cavovarus foot (eg, Charcot-Marie-tooth disease), or type 2 Brodsky Charcot hindfoot arthropathy. Triple arthrodesis utilizing solid (noncannulated) screws is a technically demanding procedure because accurate placement of these screws is complex. Cannulated screws have become popular because of their easier insertion than solid screws and because of a lower chance of loss of reduction during insertion. The traditional triple hindfoot arthrodesis is performed using 2 separate incisions and also by the single medial approach with cannulated screws. Both procedures are described and illustrated in detail in this paper. We recommend inserting screws starting with the joint that has the greatest preoperative deformity and address soft tissue contractures if needed earlier during surgery. Appropriate placement of screws is very important for stable reconstruction and good postoperative outcomes. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.