Outcomes of naviculocuneiform arthrodesis with and without adjunct arthrodesis

Abstract

Naviculocuneiform (NC) arthrodesis is considered a challenging procedure compared to arthrodesis of other medial column joints and/or hindfoot fusions. The objectives of this study were to 1) report the incidence of nonunion and complications after NC arthrodesis with or without adjunct joint arthrodesis, and 2) report incidences in which a fixation method was used and report how many cuneiform joints were fused. A retrospective review of medical charts and radiographs were performed on patients from 1/2013 through 11/2023 at a single institution in the Midwest region. 137 cases included and 90 (66%) adjunct joint arthrodesis incidents. The overall nonunion rate was 25% (34/137 cases) and overall revision rate was 15% (21/137 cases). The nonunion rate with adjunct joint arthrodesis was 26% (23/90 cases) and without was 23% (11/47 cases). The screws-alone fixation had the lowest nonunion rate of 20% (4/20 cases). The overall complication rate was 47% (65/137 cases), and the most common cause was hardware issues (31%, 43/137 cases). Fixating all three joints regardless of fixation constructs resulted in 18% (5/28 cases) nonunion. Crossed screws with medial plate fixation when fixated medial and middle cuneiform joints had the highest nonunion rates (24%, 10/42 cases) while fixation with screws and staples had the lowest nonunion rates (11%, 1/9 cases). In conclusion, the choice of fixation technique and number of cuneiform joints fused could affect the success of NC arthrodesis. Implementing proper cuneiform joints fusion and recognizing the limitations of fixation techniques potentially reduces the risk of nonunion and complications.