Technique, Complications, and Mid-Term Results of Hindfoot Arthrodesis with a Posterior Blade Plate

Abstract

Category: Ankle Arthritis Introduction/Purpose: Previous hindfoot surgeries present a unique challenge in performing hindfoot arthrodesis. The use of a blade plate construct is widely accepted, however there is limited data supporting the use of a posterior approach to blade plate arthrodesis. The purpose of this study was to (1) describe demographics of patients who underwent posterior hindfoot arthrodesis using a blade plate, (2) describe our surgical technique, (3) discuss outcomes, and (4) compare patients with and without complications. Methods: Between December 2001 and July 2014, 42 patients underwent hindfoot arthrodesis using a posterior blade plate and 40 patients were included in this study. Demographic data including age, gender, body mass index, smoking status, and comorbidities were analyzed. Surgical data including indication for the surgery, previous surgical treatment, and additional surgical procedures were reviewed. Weight-bearing radiographs were used to assess the fusion rate. Clinic and surgery notes were reviewed for possible intraoperative, perioperative, and postoperative complications. Univariate analysis was performed to compare patients who experienced complications with those who did not. There were 27 male and 13 female patients with a mean age of 56.4 ± 13.4 years. Twenty-eight patients had a tibiotalocalcaneal arthrodesis in a primary (n=6), primary staged (n=10), revision (n=9), or revision staged (n=3) setting. Eleven patients had ankle arthrodesis (primary n=7, revision n=4). The latest follow-up averaged 46.5 ± 27.5 months (range, 13.7-137.2 months). Results: Patients had a median of two previous hindfoot or ankle surgeries (range, 0-9 surgeries). Thirty-three of 40 (82%) procedures fused at an average of 24.4 ± 21.2 weeks. Four patients had a delayed osseous union. Seven patients had a nonunion, including ankle (n=3), subtalar (n=3), and both (n=1) joints. Patient groups with, and without primary solid osseous unions were comparable in terms of demographic data and surgical details. Eighteen major and eight minor complications were observed. Patients with or without complications were comparable in terms of demographic data and surgical characteristics. In total six patients (15%) underwent below knee amputation due to unsatisfactory results. Conclusion: Indications for hindfoot arthrodesis using posterior blade plate fixation include a diverse patient population. These surgeries may be performed as primary, revision, primary staged, or revision staged procedures. Most of the patients in our cohort had previous ankle/hindfoot surgeries. The fusion rate is lower than in primary hindfoot arthrodesis as reported in the current literature. The complications rate is high.