Talonavicular Arthrodesis Research Articles

A Modified Fixation Method for Talonavicular Arthrodesis in the Treatment of Müller-Weiss Disease: The Use of the Shape-Memory Alloy Staple as an Adjunct.

Arthrodesis, usage of metallic implants for internal fixation, is commonly employed as the primary treatment modality for Müller-Weiss disease (MWD). Nevertheless, the efficacy of the current methods of fixation leaves room for improvement. Inadequate fixation strength and the risk of fixation failure are both critical concerns requiring attention. This study explored the clinical effects of implementing a modified fixation technique in talonavicular arthrodesis for the treatment of MWD. A total of 14 cases diagnosed with MWD undergoing talonavicular (TN) arthrodesis from January 2021 toMarch 2023 were included in the retrospective study. The fixation method for fusion involved the use of screws, with additional support from the shape-memory alloy (SMA) staple. Relevant clinical outcomes and complications were evaluated preoperatively and postoperatively. Paired-samples t-test was used for all data comparisons. Radiographic evidence confirmed solid fusion, and follow-up evaluations showed satisfactory results in all cases. The American Orthopedic Foot and Ankle Society (AOFAS) scores were elevated from 32.21 ± 4.0 (range: 22-38) preoperatively to 86.5 ± 2.7 (range: 81-90) postoperatively (p < 0.001). The visual analog scale (VAS) scores declined from 7.40 ± 0.8 (range: 6-8.5) preoperatively to 1.21 ± 1.1 (range: 0-3) postoperatively (p < 0.001). The lateral Meary's angle changed from 13.50 ± 5.2 (range: 8-24) preoperatively to 4.14 ± 2.9 (range: 1-11) degrees postoperatively (p < 0.001). The calcaneal pitch angle increased from 10.07 ± 4.0 (range: 5-19) preoperatively to 14.35 ± 4.0 (range: 8-21) degrees postoperatively (p < 0.001). The talar-first metatarsal angle decreased from 11.71 ± 3.8 (range: 8-18) preoperatively to 4.28 ± 3.1 (range: 0-9) degrees postoperatively (p < 0.001). One patient was observed to experience delayed wound healing and wound infection. No nerve damage, malunion, pseudoarthrosis, or fixation failure were observed. The results indicated that the fusion of the TN joint using a combination of screws and shape memory alloy staples, could lead to favorable clinical outcomes and significantly enhance the quality of life for patients with MWD. This technique is not only safe and effective but also straightforward to perform.

Influence of Isolated Talonavicular and Subtalar Joint Arthrodesis on Hindfoot Kinematics and Range of Motion During Cadaveric Gait Simulation.

Isolated subtalar and talonavicular joint arthrodeses have been associated with adjacent joint arthritis and altered hindfoot kinematics during simplified loading scenarios. However, the effect on kinematics during dynamic activity is unknown. This study assessed changes in subtalar and talonavicular kinematics after isolated talonavicular (TNiso) and subtalar (STiso) arthrodesis, respectively, during stance simulations. Fourteen midtibia specimens received either a TNiso or STiso arthrodesis, with 7 randomized to each group. A 6-degree-of-freedom robot sequentially simulated the stance phase for the intact and arthrodesis conditions. Bootstrapped bias-corrected 95% CIs of the talonavicular and subtalar joint kinematics were calculated and compared between conditions. The TNiso decreased subtalar inversion, adduction, and plantarflexion in late stance (P < .05). The subtalar range of motion in the sagittal and coronal planes decreased by 40% (P = .009) and 46% (P = .002), respectively. No significant changes in talonavicular joint kinematics were observed after isolated subtalar arthrodesis; however, the range of motion was reduced by 61% (P = .007) and 50% (P = .003) in the coronal and axial planes, respectively. In this model for arthrodesis, changes in subtalar kinematics and motion restriction were observed after isolated talonavicular arthrodesis, and motion restriction was observed after isolated subtalar arthrodesis. Surprisingly, talonavicular kinematics did not appear to change after isolated subtalar arthrodesis. Both joint fusions substantially decrease the motion of the reciprocal adjacent joint. Surgeons should be aware that the collateral costs with talonavicular fusion appear higher, and it has a significant effect on subtalar kinematics during the toe-off phase of gait.

ARTHROSCOPIC ARTHRODESIS OF THE ISOLATED TALONAVICULAR JOINT

BackgroundWhereas arthroscopic arthrodesis of the ankle is commonplace and of the subtalar joint is established, reports of arthroscopic talo-navicular fusion are a rarity.AimTo review a case series to establish if arthroscopic talo-navicular arthrodesis is a feasible surgical option.MethodsArthroscopic decortication of the talo-navicular joint is performed via x1-2 sinus tarsi portals and x1-2 accessory talo-navicular portals using a standard arthroscope and a 4.5 barrel burr. Internal fixation is by a 5mm screw from the navicular tuberosity and x2 headless compression screws introduced under image intensification from the dorsal navicular to the talar head. Between 2004 and 2017 a consecutive series of 164 patients underwent arthroscopic hindfoot arthrodeses of which 72 involved the talo-navicular joint. Only 13 procedures were of that joint alone in unsullied feet. The medical records of these 13 patients were reviewed to assess radiological fusion, complications and improvement of pre-operative state.ResultsAll Talo-navicular joints were successfully decorticated. All united radiologically by a mean 4.4 months (range 3–8). There were no major complications. All patients reported improvement to their pre-operative symptoms but one patient developed lateral column pain requiring fusion.ConclusionsArthroscopic Talo-navicular arthrodesis is technically feasible with good rates of union. Complications were rare, making the technique attractive when encountering a poor soft tissue envelope. The surgery cannot be used if bone grafting is required. Long term discomfort can arise from adjacent joints. Accurate alignment is critical.

MULLER-WEISS DISEASE: PROPOSED CLASSIFICATION AND TREATMENT ALGORITHM

Muller-Weiss disease is an uncommon condition with unclear etiology and no gold standard treatment. The question arises; which joints to fuse? Although no consensuses prevail, one must postulate fusion should include those affected. Consequently, to establish an algorithm for its surgical management we set out to study clinical and radiographic features with use of SPECT-CT and a literature review.57 consecutive feet presenting with Muller-Weiss disease analysed; 15 men, 25 women, age 22–84. Condition bilateral in 17, left side 16, right in 7 patients. Specific history and examination by senior author. Radiographic series and SPECT-CT obtained with surgery performed on significantly symptomatic feet. Measurements of Meary-Tomeno angles, anteroposterior thickness of navicular at the midpoint of each naviculo-cuneiform, alongside the medial extrusion distance and percentage of compression in each case performed. Poor correlation between Meary's angle and 1) degree of compression at naviculo-cuneiform joints, 2) degree of extrusion 3) compression vs extrusion using R2 coefficient of determination (invalidating Maceira et al. classification). In unilateral cases, extrusion significantly greater on affected side 94.7% (P&lt; 0.001 Fisher exact test). Degree of extrusion significantly greater in bilateral than unilateral cases (p=0.004 unpaired T test). Valgus hindfoot and Meary's negative most common pattern with no correlation between heel alignment and Meary's R2 = 0.003. SPECT-CT useful to determine subtalar involvement in ‘stage 2 disease.’Following review of cases and published literature we propose the following classification for Muller-Weiss disease with treatment algorithm. 3 Stage delineation; Stage 1 (Normal hindfoot alignment); 1A. Talonavicular disease only - Isolated Talonavicular arthrodesis 1B. Talonavicular + Subtalar; double medial or triple arthrodesis. Stage 2. Talonavicular + Naviculocuneiform; 2A. Adequate bone stock - Talo-naviculo-cuneiform arthrodesis, 2B. Inadequate bone stock +- subtalar disease; Talo-naviculo-cuneiform arthrodesis with tricortical bone graft (Mayich). Stage 3; Asymmetric ankle varus. Pantalar arthrodesis Double/triple/TNC/TAR arthrodesis with hindfoot re-alignment.

Arthroscopic Talonavicular Arthrodesis for the Management of Talonavicular Osteoarthritis

The talonavicular joint is a common site for osteoarthritis of the foot. Talonavicular arthrodesis is the surgical treatment for symptomatic talonavicular osteoarthritis. Classically, this is performed via an open approach and is associated with a rate of nonunion that ranges from 3% to 37%. Arthroscopic talonavicular arthrodesis has been proposed to provide better intra-articular visualization, conserve bone blood supply to improve the union rate, and reduce soft-tissue complications such as wound dehiscence, infection, and neurovascular injury. The purpose of this Technical Note is to describe the details of arthroscopic talonavicular arthrodesis for management of talonavicular osteoarthritis.

Simultaneous subtalar arthroeresis, midfoot soft tissue release, and talo-navicular arthrodesis in children with planovalgus neurologic foot.

Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA). A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6years (6-17). Mean follow-up was 7 ± 2.9years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01. Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108feet (4.6%) and 2feet (3.3%) had delayed medial wound healing. SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications. IV.

Equino-plano-valgus foot in cerebral palsy – clinical principles and surgical techniques review (world perspective). Report from the 5th edition of the Transatlantic Orthopedic Surgery Webinar 2023

Introduction. The fifth edition of the Transatlantic Orthopedic Surgery Webinar 2023 occurred on December 4, 2023. The webinar’s main topic was treating equino-plano-valgus foot in children with cerebral palsy (CP). The event included speakers from Austria, Australia, China, India, Canada, Germany, Poland, Sweden, Turkey, the USA and the UK. Results. The first general session presented epidemiology, biomechanics, muscle function, equinoplano- valgus foot prevention options, and the Silverskiöld test in clinical assessment. It also discussed the principles of deformation treatment, options for orthotic treatment, and pathology treatment in adults suffering from CP. The surgical sessions presented comprehensive surgical techniques for the treatment of clubfoot equinus: sliding calcaneal osteotomy, lateral column lengthening with talonavicular arthrodesis, use of an expandable cage for the lateral column lengthening, double arthrodesis with the transfer of the peroneal muscles, percutaneous soft tissue release with/without arthroereisis, lateral column lengthening with arthroereisis, Grice procedure with talonavicular arthrodesis, lateral column lengthening with medial cuneiform bone plantarflexion osteotomy, lateral column lengthening with duplication of the talonavicular capsule, talonavicular and calcaneocuboid arthrodesis, transfer of the tibialis anterior muscle to the peroneal tertius muscle. The second general session presented methods of assessing the results of clubfoot treatment and postoperative rehabilitation protocols involving upright positioning and walking. Conclusion. The most important conclusions from the event are: clinical assessment and understanding the pathophysiology of the defect is crucial for its proper treatment; non-surgical treatment is recommended under the age of 6; between the ages of 6 and 14, surgical methods that preserve joint function predominate; after the age of 14 a large percentage of patients require performing joint arthrodesis. Nevertheless, arthrodesis should be avoided to correct flexible deformities and to treat patients with high functional requirements. The webinar audience included 583 people from 50 countries. Most participants came from Poland, Spain, Turkey, and Great Britain.

Activated nitinol compression staples are associated with favorable biomechanical properties for talonavicular arthrodesis

BackgroundNitinol compression staple use in foot and ankle arthrodesis procedures, including for the talonavicular joint, has gained acceptance. A previous study provided evidence for using nitinol compression staples in talonavicular arthrodesis (TNA) based on functional biomechanical testing comparisons to “gold standard” lag screw fixation. This study aimed to further compare the functional biomechanical properties of nitinol compression staple fixation to lag screw fixation for arthrodesis of the talonavicular joint. Body-temperature incubation and ankle inversion and eversion loading sequences were added to previously reported biomechanical testing. MethodsRobotic testing was performed on cadaveric feet (n = 10; 5 matched pairs) after TNA using either two nitinol compression staples or two fully threaded lag screws. TNA method was randomized, alternating between matched-pairs of left and right feet. After surgical stabilization, specimens were incubated at 38 °C for 24 h to simulate the initial postoperative period in a patient. After plantarflexion and dorsiflexion testing, the specimens underwent inversion and eversion testing, cycling from 20° inversion to 10° eversion for 10 cycles. Displacements were tracked using optical tracking markers. Significant (p < 0.05) differences between staple versus screw fixation cohorts were determined using paired t-Tests. ResultsAll specimens completed testing with none experiencing failure at the TNF. No statistically significant differences in functional biomechanical testing properties were noted between nitinol compression staple fixation and lag screw fixation for TNA. ConclusionThe study findings provide additional support for nitinol compression staple fixation as an option for talonavicular arthrodesis fixation. Taken together, the results of functional biomechanical testing studies have provided sufficient evidence for initiation of a prospective clinical outcomes study using nitinol compression staples for talonavicular arthrodesis fixation at our institution.

Comparison of the Acute Postoperative Complications Between Isolated Talonavicular Versus Talonavicular and Subtalar (Double) Arthrodesis in Flatfoot Deformity.

Both isolated talonavicular arthrodesis and talonavicular and subtalar (such as double) arthrodesis can be effective treatments for adult-acquired flatfoot deformity (AAFD) with good success rates, but double arthrodesis has become more commonly performed in recent years. The purpose of this study is to evaluate whether isolated talonavicular versus talonavicular and subtalar arthrodesis led to significantly different 30-day postoperative complication rates in patients with AAFD. We performed a retrospective review to identify a large cohort of adult patients with the diagnosis of AAFD or posterior tibial tendon deformity (PTTD) who underwent isolated talonavicular or talonavicular and subtalar arthrodesis between 2006 and 2020 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). To investigate whether there was a difference in complication rate between the 2 surgical cohorts, we estimated logistic regression models and log-binomial models on each of the outcomes while also adjusting for sex and age. We found that there was no significant difference in the rate of major complications (P = .567) or readmissions (P = .567) between patients who underwent isolated talonavicular versus talonavicular and subtalar arthrodesis for AAFD. However, there was a significantly higher rate of minor complications in patients who underwent isolated talonavicular arthrodesis when compared with patients who underwent talonavicular and subtalar arthrodesis (P = .009). This study found that there was no increased risk of 30-day postoperative complications or readmissions with talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis for AAFD. In addition, there was no increased risk of major complications for talonavicular and subtalar arthrodesis when compared with isolated talonavicular arthrodesis, and isolated talonavicular arthrodesis actually carried a higher risk of minor complications for this surgical cohort. This may provide valuable information for surgeons considering surgical treatment for a particular case of AAFD. Level III.

Isolated Talonavicular Arthrodesis as Treatment for Flexible Progressive Collapsing Foot Deformity: A Case Series.

For the younger, more active patient with flexible symptomatic progressive collapsing foot deformity (PCFD), joint-sparing procedures may be preferred to preserve functional motion. Isolated talonavicular (TN) arthrodesis has been described for treatment of rigid and flexible PCFD for patients that are older and less active whose deformity is still correctable through the TN joint. The purpose of this study was to evaluate radiographic and clinical outcomes in patients with PCFD treated with isolated triplanar correction with a TN joint arthrodesis. Forty-nine patients (53 feet) with flexible PCFD underwent isolated TN arthrodesis. Weightbearing radiographs were performed pre- and postoperatively, and measurements included lateral talar-first metatarsal angle, calcaneal pitch, TN coverage angle, and the anteroposterior (AP) talar-first metatarsal angle. The Foot and Ankle Ability Measure (FAAM) and Veterans-Rand 12-Item Health Survey (VR-12) scores were also collected. Thirty-five females and 14 males were evaluated with a mean age of 63 years, at an average follow-up of 41.3 months. Significant improvements were found radiographically. Lateral radiographs demonstrated improvements in lateral talar-first metatarsal angle from 25.2 degrees preoperatively to 9.5 degrees postoperatively (P < .001) and calcaneal pitch from 14.9 degrees preoperatively to 17.5 degrees postoperatively (P < .001). AP radiographs showed the TN coverage angle improving from 35.0 degrees to 4.9 degrees postoperatively (P < .001) and AP talar-first metatarsal angle improving from 17.3 degrees to 5.9 degrees postoperatively (P < .001). Clinical outcomes were improved in the FAAM pain score (48.6 to 39.2, P = .130), FAAM ADL score (53.8 to 69.2, P = .002), FAAM Sport score (29.5 to 40.7, P = .099), and the overall FAAM score (47.7 to 63.1, P = .006). Patient satisfaction with medical care was 85.2/100 postoperatively. Isolated TN arthrodesis is a viable surgical option for older, lower-demand patients with flexible PCFD. This study demonstrated significant improvements in radiographic alignment and FAAM scores. Comparative studies with other surgical procedures should be performed to determine which is the best technique for older, lower-demand patients with flexible PCFD. Level III, retrospective cohort study.

Lateral Fixation for Talonavicular Arthrodesis Using the Medial Approach: Technique Tip.

Lateral Fixation for Talonavicular Arthrodesis Using the Medial Approach: Technique Tip.

Outcomes of Selective Arthrodesis Based on Joints Affected in 33 Feet With Müller-Weiss Disease

No consensus exists regarding operative treatment of Müller-Weiss disease (MWD). Its only classification is based solely on Méary's angle and serves neither as guide to management nor prognosis. We report on 33 feet that underwent surgery following failed conservative management. Treatment was directed towards joint(s) involved, as determined by clinical examination, plain radiography and SPECT-CT. Thus, surgery consisted of isolated talonavicular in 6 feet, triple in 8, subtalar and talonavicular in 7, talonaviculocuneiform in 4, talonaviculocuneiform with interpositional tricortical iliac crest graft in 6 and pantalar arthrodesis in 2. PROMIS scores for pain interference and depression decreased significantly (p < .001) with significant accompanying increase in physical function (p = .003). Union occurred in 31 of 33 feet (94%) with complete resolution of pain at an average follow-up of 84 months. Of the 2 nonunions, 1 had fracture through the lateral navicular, and the other marked sclerosis and avascularity of the lateral navicular. We describe our pathways for selecting arthrodesis based on the joints affected. Isolated talonavicular arthrodesis was performed in early stages of MWD, which begins at the talonavicular articulation. When disease extended to both sides of the navicular, we performed talonaviculocuneiform arthrodesis. When considering isolated talonavicular, double medial or triple arthrodesis, there should be adequate cancellous bone stock remaining in the lateral part of the navicular, as determined on medial oblique radiographs and CT scan. In case of inadequate bone stock or fracture through the lateral navicular, talonaviculocuneiform arthrodesis with interpositional iliac crest bone graft is recommended.

Revision Total Ankle Arthroplasty Outcomes in a Large Single-Center Series: Evaluation of Coronal Plane Deformity Correction and Patient Reported Measures

Category: Ankle Arthritis Introduction/Purpose: As total ankle arthroplasty (TAA) rises in popularity nationwide, the incidence of major complications and need for revision TAA will continue to increase. A better understanding of the ability to durably correct deformity and improve patient reported outcomes (PROs) in the TAA revision setting is paramount for surgeons facing the impending wave of failed TAA. Thus, the purpose of this study was to present the largest single-center case series of revision TAA to date and to evaluate improvement in PROs and maintenance of correction of coronal plane deformity in patients undergoing this procedure. Methods: This was a single-center, retrospective review of 87 revision TAAs performed between 2007 and 2022. Reoperations for cyst formations only or without metallic component exchange were excluded. The two most common implants used for revision TAA were Inbone II (n=65) and Inbone I (n=14). Mean follow-up was 2.8 ± 2.9 years. Data on patient preoperative characteristics, concurrent procedures, and postoperative complications were collected. The primary outcome measures were time to major complication, reoperation, and infection. Secondary outcomes included PROs and correction of coronal plane deformity measured from both the tibial plafond and talar articulating surface from pre- to post-operatively. Cox regression analyses were performed to compute survivorship. Results: The most common concurrent procedures performed concomitantly with revision TAA were gastrocnemius recession (n=31, 35.6%), subtalar arthrodesis (n=18, 20.7%), and talonavicular arthrodesis (n=5, 5.7%). Mean preoperative coronal plane deformity measured off both the tibial plafond and talar articular surface improved after revision TAA. 1- and 5-year survivorship from major complication, reoperation, and infection is shown in Table 2. Fourteen patients underwent subsequent revision, including TAA (n= 6, 6.9%), arthrodesis (n= 4, 4.6%), below-the-knee amputation (n= 2, 2.3%), or implantation of an antibiotic spacer (n= 2, 2.3%). At one-year postoperatively, mean VAS pain score, SF36, and AOFAS Hindfoot score was 18.2 ± 16.0, 73.0 ± 13.3, and 68.8 ±:9.3, respectively, representing an improvement in PROs after revision TAA. Conclusion: In the largest single-center series of patients undergoing single or double component exchange revision TAA, we demonstrate durable improvements in coronal plane deformity measured off both the tibial plafond and talar articular surface. We also noted 63.0% survivorship with regards to reoperation and improvements in average PROs across the cohort. Overall, revision TAA is a successful procedure, but is associated with higher failure rates at 5 years than primary TAA.

Surgical Construct Type Is Associated With Time to Fusion and Reoperation Rate in Double and Isolated Talonavicular Arthrodeses.

This study evaluates the effect of surgical construct on postoperative outcomes in patients undergoing isolated talonavicular (TN) or double (TN and subtalar ST) arthrodesis. TN constructs included plate and screw, screw and staple, and isolated staple constructs. Subtalar constructs included 1- and 2-screw constructs. Retrospective chart review identified 52 patients who underwent double or isolated TN arthrodesis between 2016 and 2021 by a single fellowship-trained foot and ankle surgeon with minimum 6 months of follow-up (mean = 1.62 years, range = 0.50-4.39 years). Data collected included demographics, medical history, surgical indication, surgical constructs used, complications, reoperations, patient-reported outcome measures, and radiographic measures. Overall complication and reoperation rates were 26.3% and 12.3%, respectively. Among TN constructs, time to ST (P = .026) and TN (P = .018) fusion was significantly slower among patients receiving a plate and screw construct. Complication rate did not differ, but reoperation rate was significantly higher for plate and screw TN constructs (P = .039). Postoperative Foot and Ankle Outcome Score (FAOS) Quality of Life (P = .028) and Total (P = .016) scores were significantly better among plate and screw TN constructs. Utilization of screw and staple or isolated staple construct have significantly quicker time to fusion and lower reoperation rates than plate and screw constructs for the TN joint. Level III: Retrospective cohort study.

Talonavicular arthrodesis: Does the IOFiX system provide safe and reliable fixation?

AimsTalonavicular (TN) arthrodesis is a common procedure to treat arthritis of the TN joint.It can also form part of a wider triple fusion to restore the architecture of the foot.Traditional methods of arthrodesis are not universally successful. The aim of this study was to evaluate the clinical and radiological outcomes of those who had a TN fusion using the IOFiX system.Data was collected retrospectively from the hospital operation database. Inclusion criteria included patients who underwent a TN fusion between 2012 and 19 with the IOFiX system. All patients were over 16 years of age and at least one year post operation.Patient demographics were obtained, as well as rate of union and rate of re-operation for analysis. Results35 patients were identified. The mean age was 58 years (range 34–85). The most common indication was osteoarthritis of the TN joint (n = 19), followed by acquired adult flat foot (n = 8), rheumatoid arthritis (n = 3), avascular necrosis (n = 2) and a previous nonunion.(n = 1). 9 % (n = 3) of patients did not achieve union by one year and 14 % (n = 5) required another operation subsequent to their initial surgery: four to remove metalwork, and one to treat non-union of the arthrodesis. The use of bone graft did not affect complication rates. TN fusion, when performed as part of a triple fusion, showed a tendency for reducing the rate of non-union, however this did not achieve statical significance. ConclusionThis study suggests that the IOFiX system offers a reliable and acceptable alternative technique for patients undergoing a TN fusion. Further work is required to assess if early signs of improved outcome when used in triple fusion, over isolated TN fusion,are significant.

Biomechanical comparison of nitinol compression staples versus fully threaded lag screws for talonavicular arthrodesis

BackgroundTalonavicular arthrodesis (TNA) is indicated for treatment of disorders that require immobilization of the hindfoot. Lag screw fixation is considered the reference standard technique for TNA. Despite consistently favorable clinical results using lag screw fixation, it is still associated with higher than desired complication and failure rates. Nitinol compression staples have been used for TNA based on potential advantages over lag screw fixation. However, functional biomechanical data comparing lag screw and nitinol compression staples for TNA are lacking. Therefore, the objective of this study was to compare nitinol compression staples to fully threaded lag screws for use in TNA with respect to their biomechanical properties during functional robotic testing. MethodsTNA was performed on cadaveric feet (n = 12; 6 matched pairs) using either two nitinol compression staples (Arthrex, Naples, FL) or two fully threaded lag screws (Arthrex, Naples, FL) in random order, alternating between paired left and right feet. After instrumentation, specimens were mounting in a robotic testing system and loaded at 89 N/sec from 30 N to 445 N for 1 min. Then, continuous compressive load of 445 N was applied while cycling from 30° plantarflexion to 15° dorsiflexion for 10 cycles. Optical tracking markers attached to the talus and navicular bone tracked displacements. Translation data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p < 0.05) differences between fixation methods were determined using paired t-Tests for each measured variable. ResultsThere were no statistically significant differences between staples and screws for translation in X, Y, or Z planes. When comparing rotation (roll, pitch, and yaw), there were no statistically significant differences with the exception of increased roll rotation for staple fixation versus lag screw fixation during static compression testing (p = 0.009). ConclusionBased on comparison to the reference standard lag screw fixation for clinically relevant biomechanical properties measured during functional robotic testing of the hindfoot, nitinol compression staples are a viable option for talonavicular arthrodesis.

Surgical Construct Associated with Time to Fusion in Double and Isolated Talonavicular Arthrodeses

Category: Hindfoot; Ankle Arthritis Introduction/ Purpose: Double arthrodesis of the subtalar (ST) and talonavicular (TN) joints, along with isolated TN arthrodesis, are commonly performed for hindfoot osteoarthritis and rigid hindfoot deformity. Few studies have examined the effects of the type of ST and TN fixation constructs on nonunion rate following double and isolated TN arthrodesis procedures. This study evaluates the effect of surgical construct on the union rate and time to fusion in patients undergoing double or isolated TN arthrodesis. Methods: Retrospective chart review identified 52 patients (52 feet) who underwent double or isolated TN arthrodesis between 2016 and 2021 by a fellowship-trained foot and ankle surgeon with at least six months of follow-up (mean=1.62 years, range=0.50- 4.39 years). Data collected included demographics, medical history, surgical indication, surgical constructs used, complications, reoperations, patient-reported outcome measures, and radiographic measures. ST constructs included one (n=4) or two (n=44; parallel=43, divergent=1) cannulated screws, while TN constructs included dorsal plate (n=2), dorsal plate and screw (n=10), isolated screws (n=3) screw and staple (n=29), or isolated staples (n=13). At the time of their surgery, the mean age was 60.39 (range, 17-80) years, mean body mass index (BMI) was 33.89 (range, 20.74-48.41) kg/m2, and most subjects were non-smokers (94.7%). Mean follow-up duration was 1.62 (range, 0.50-4.39) years. Results: Overall complication and reoperation rates were 26.3% and 12.3%, respectively. Among TN constructs, the time to ST (p=.026) and TN (p=.018) fusion was statistically significantly slower among patients receiving a plate and screw TN construct. Complication rate did not differ by construct, but reoperation rate was significantly higher for the plate and screw TN construct (p=.039). Postoperative Foot and Ankle Outcome Score (FAOS) Quality of Life (p=.028) and Total (p=.016) scores were significantly better among plate and screw TN constructs. Conclusion: The utilization of a screw and staple or isolated staple construct have a statistically significantly quicker time to fusion and lower reoperation rates than plate and screw constructs for the TN joint. These findings can be used to guide clinician decision-making while allowing physicians to take their personal construct preference into account, as well as serve as a useful starting point to other researchers interested in investigating the impact of surgical constructs on ST and TN fusions.

Subtalar and talonavicular arthrodesis under lateral arthroscopy

Open hindfoot surgery incurs certain complications: notably, infection and skin problems. Arthroscopic subtalar arthrodesis reduced the complications rate while ensuring >90% fusion. To date, arthroscopy is little used for talonavicular arthrodesis. Here, we describe subtalar and talonavicular arthrodesis under arthroscopy via 2 lateral portals around the sinus tarsi.Level of evidence: IV.

Isolated Talonavicular Arthrodesis as Treatment for Flexible Progressive Collapsing Foot Deformity: A Case Series

Category: Hindfoot; Other Introduction/Purpose: Progressive collapsing foot deformity (PCFD) remains a challenging condition for foot and ankle surgeons to treat. While there exists more clarity on the treatment for end-stage rigid deformities involving PCFD, there is still significant debate over different surgical treatment options for the flexible collapsing foot. Common surgical corrections for flexible PCFD include the 'All-American Procedure' popularized by Manoli in the 1990s. Isolated talonavicular (TN) arthrodesis has also been described for the treatment of flexible PCFD. The primary objective of this study was to evaluate clinical and radiographic outcomes in patients with AAFD treated with isolated tri-planar corrective TN arthrodesis. A secondary objective was to establish whether there is a correlation between radiographic outcomes and clinical outcomes. Methods: Fifty-four patients (59 feet) from July 2013 to October 2020 with flexible PCFD underwent surgical treatment with isolated TN arthrodesis. Patients with other arthrodesis or hindfoot osteotomies were excluded. Concomitant gastrocnemius lengthening and toe deformity correction procedures were not an exclusion criterion. Weight-bearing radiographs were performed pre- and postoperatively, with Meary angle (or lateral talo-first metatarsal angle) and calcaneal pitch measured on lateral view. The degree of TN coverage on antero-posterior (AP) radiographs were measured with the TN coverage angle and the degree of first ray angular deformity was measured using Simmon angle (or AP talo-first metatarsal angle). Angles were measured by a foot and ankle fellow. The Foot &amp; Ankle Ability Measure (FAAM) and Veterans-Rand 12 Item Health Survey (VR- 12) were used to clinically evaluate the patient. Results: Thirty-seven females and seventeen males were evaluated with a mean age 61 years at the time of surgery and an average length of follow up of 19 months. There were significant improvements in deformity correction found in this study. Radiographically, the lateral radiographs demonstrated Meary angle correction from 27 degrees pre-operatively to 9 degrees post- operatively (p&lt;0.001) and calcaneal pitch improving from 15 degrees pre-operatively to 18 degrees post operatively (p&lt;.001). AP radiographic analysis demonstrated TN coverage angle improving from 35 degrees pre-operatively to 5 degrees post-operatively (p&lt;0.001) and Simmon angle improving from 20 degrees pre-operatively to 6 degrees, post-operatively (p&lt;.001). The only statistically significant improvement in clinical outcomes was in the FAAM score (pre-operative score 48.48, post-operative score 58.45 (p&lt;.001)). Conclusion: Isolated TN arthrodesis is a viable option for multi-planar deformity correction in patients with flexible PCFD. Not only did it provide significant improvements in radiographic alignment, it also provided improved functional outcomes as demonstrated on FAAM scores. Comparative studies with other surgical treatment techniques such as the 'All-American Procedure' should be performed to determine which is the best technique for patients with flexible PCFD.

Patient-Reported Outcomes Following a Two-Stage Revision Total Ankle Arthroplasty for Chronic Periprosthetic Joint Infections

Category: Ankle Arthritis; Ankle Introduction/Purpose: Previous studies have documented improvement in patient-reported outcomes (PROs) following primary total ankle arthroplasty (TAA) with mean two-year postoperative Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) scores reported as &gt;80 (Norvell et al. JBJS 2019). As TAAs become more common, complications including chronic prosthetic joint infections (PJIs) will be encountered more frequently. Although well-documented in the hip and knee arthroplasty literature, no studies have reported on PROs following a two-stage revision procedure for a chronic PJI after a TAA. The primary purpose of this study was to investigate clinical outcomes at a minimum of two-years postoperatively following a two-stage revision TAA for a chronic PJI. Secondary outcomes were to identify the need for soft-tissue coverage and postoperative complications following the revision. Methods: Patients who underwent a two-stage revision TAA for a chronic PJI (&gt;4 weeks after a primary TAA) between January 2010 and December 2019 were eligible to be included in this study. Chronic PJI was defined as a sinus tract that directly communicated with the prosthesis or the same organism identified in 2 synovial fluid samples. Patients were excluded if they did not have at least two-year postoperative Foot and Ankle Ability Measure (FAAM) scores, which are validated patient-reported outcome tools. Twelve patients were eligible to be included in this study. One patient died prior to two-year follow-up, which left 11 patients available for analysis. All eleven patients underwent reimplantation with a stemmed tibial implant and flat-cut talus. Patients were contacted to determine if they had any additional reoperations since their last office note. The data was found not to be normally distributed; therefore, medians and interquartile ranges (IQRs) are reported. Results: The median time from primary TAA to resection was 17 months (IQR 2-24 months). Seven of 10 patients required a free flap for soft-tissue coverage prior to reimplantation. At a median of 3.0 years (IQR 2.0-4.0 years) following the second stage of their revision arthroplasty, the median FAAM ADL, Sports, Current Function, and Current Sports Level scores were 60.7 (IQR 52.4, 79.8), 31.3 (IQR 9.4, 40.6), 70 (IQR 25.0, 90.0), and 10 (IQR 0.0, 75.0) (Figure 1). Patients rated their current level of function as 'Severely Abnormal' in 3 patients, 'Abnormal' in 4 patients, 'Nearly Normal' in 3 patients, and 'Normal' in 1 patient. Six patients required a reoperation including three patients who underwent a subsequent irrigation and debridement, one patient who had a below knee amputation, one patient who required a dorsiflexion first metatarsal osteotomy, and one patient who had a subtalar and talonavicular arthrodesis. Conclusion: Our study suggests that a two-stage revision TAA is a viable option for patients with a chronic PJI with 90.9% of patients retaining their metal components at a minimum two-year follow-up. However, patients who undergo a two-stage revision TAA for a chronic PJI have lower than previously published two-year FAAM scores and a high rate of flap coverage and reoperation. Only 36.4% of patients rated their function as 'Normal' or 'Near Normal.' This data may be used to help counsel patients about the expected outcome following a two-stage revision TAA for a chronic PJI.