Secondary Arthrodesis After Total Ankle Arthroplasty.

While it is thought that stresses through the subtalar and talonavicular joints will be decreased after total ankle replacement (TAR) relative to ankle fusion, progressive arthritis or deformity of these joints may require a fusion after a successful TAR. However, after ankle replacement, it is unknown how hindfoot biomechanics and blood supply may be affected. Consequently, subsequent hindfoot joint fusion may be adversely affected. We retrospectively identified a consecutive series of 1001 primary TARs performed between January 1998 and December 2014. We identified patients who underwent a secondary triple, subtalar or talonavicular arthrodesis to treat progressive arthritis or pes planus deformity. Clinical outcomes including pain and functional outcome scores, revision procedures, delayed union, nonunion, complications, and failure rates were recorded. Twenty-six patients (2.6%) required a subtalar (18), talonavicular (3), talonavicular and subtalar (3), or triple arthrodesis (2). Of these patients, 14 (54%) were males with an average age of 63.2 years and a mean 70.9 months follow-up. We then compared these patients to 13 patients who had a subtalar fusion after an ankle arthrodesis. The most common type of fixation used was 2 variable-pitch screws across each joint. Fresh-frozen allograft cancellous chips were the most common supplement to the fusion construct (80.8%). The mean time between TAR and secondary fusion procedure was 37.5 months. Overall, 92.3% of the patients went on to fusion. Two patients (7.7%) had a delayed union and 2 patients had a nonunion (7.7%) and were considered operative failures. There were 3 repeat procedures related to the arthrodesis procedure: 1 conversion of a subtalar to a triple arthrodesis, 1 revision talonavicular fusion, and 1 revision subtalar fusion. The average time to weight bearing after arthrodesis was 8.7 weeks; the mean time to radiographic and clinical fusion was 26.5 weeks. There were no secondary complications associated with the arthrodesis. Pain and functional outcome scores improved significantly. There were no differences in the rates of subsequent fusions among implant choices, though the time to fusion in the mobile-bearing prosthesis was significantly longer than the 2 fixed-bearing prostheses. Compared with the data of 13 patients with prior ipsilateral ankle arthrodeses and subtalar fusions, patients who had an ankle replacement had a higher fusion rate (P = .03) and had a similar time to fusion. Hindfoot arthrodesis following a TAR was safe and effective in improving function and pain. Additionally, a hindfoot arthrodesis following a TAR had a higher fusion rate than a subtalar fusion following an ankle arthrodesis. Although the time to healing was relatively long, various hindfoot fusions were used to treat progressive arthritis and deformity with high fusion rates. Level III, comparative case series.

Gross CE ，Lewis JS ，Adams SB ，Easley M ，DeOrio JK ，Nunley JA 2nd ... -  《-》

Hindfoot Arthritis Progression and Arthrodesis Risk After Total Ankle Replacement.

Dekker TJ ，Walton D ，Vinson EN ，Hamid KS ，Federer AE ，Easley ME ，DeOrio JK ，Nunley JA ，Adams SB Jr ... -  《-》

Cadaveric Gait Simulation of the Effect of Subtalar Arthrodesis on Total Ankle Replacement Kinematics.

Henry JK ，Sturnick D ，Rosenbaum A ，Saito GH ，Deland J ，Steineman B ，Demetracopoulos C ... -  《-》

Clinical Outcome and Fusion Rate Following Simultaneous Subtalar Fusion and Total Ankle Arthroplasty.

Patients with arthritis or severe dysfunction involving both the ankle and subtalar joints can benefit from tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. TTC fusion is considered by many as a salvage operation resulting in a stiff ankle and hindfoot, considerably limiting global foot function. With the evolution of prosthetic design and operative techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. This study included 25 patients who underwent primary TAR and simultaneous subtalar fusion between May 2011 and November 2014. Sixteen males (64%) and 9 females (36%) were enrolled with a mean age of 58 years (25-82). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2 ± 11.6 months. Radiographic examination included a postoperative computed tomographic (CT) scan obtained 12 months after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional scores were also assessed. At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92%. There was a statistically significant increase in American Orthopaedic Foot & Ankle Society ankle/hindfoot score from 27.9 to 75.1. Ankle range of motion significantly increased from 12 to 32.8 degrees. Additionally, there was a statistically significant decrease in visual analog scale pain score from 8.6 to 2.1. TAR and simultaneous subtalar joint fusion were reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopedic surgeons in determining the degree of successful fusion of subtalar arthrodesis. Level IV, case series.

Usuelli FG ，Maccario C ，Manzi L ，Gross CE ... -  《-》

Arthrodesis of the subtalar and talonavicular joints for correction of symptomatic hindfoot malalignment.

Sammarco VJ ，Magur EG ，Sammarco GJ ，Bagwe MR ... -  《-》