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Clinics in Podiatric Medicine and... Jan 2020This article discusses rearfoot fusions for foot and ankle surgeons. It establishes normal foot and ankle function primarily in the stance phase of gait. The foot is... (Review)
Review
This article discusses rearfoot fusions for foot and ankle surgeons. It establishes normal foot and ankle function primarily in the stance phase of gait. The foot is greatly affected by external and internal forces, which contribute to normal function or the need for compensatory mechanisms. As a result of compensation, many symptoms develop, often leading to debilitating disorders such as degenerative joint disease. The interaction of the ankle, subtalar, and midtarsal joints are outlined. Congenital deformities, trauma and abnormal compensation are reviewed along with corresponding sequelae. Surgery is often indicated to reduce symptoms, improve position, and help stabilize the foot.
Topics: Arthrodesis; Biomechanical Phenomena; Foot Joints; Humans; Joint Diseases; Postoperative Complications
PubMed: 31735263
DOI: 10.1016/j.cpm.2019.08.010 -
Clinics in Podiatric Medicine and... Jul 2023The arthroscopic approach provides a manageable postoperative course in terms of wound healing, pain control, and bone healing when compared with an open procedure. In... (Review)
Review
The arthroscopic approach provides a manageable postoperative course in terms of wound healing, pain control, and bone healing when compared with an open procedure. In particular, posterior arthroscopic subtalar joint arthrodesis (PASTA) allows a reproducible and viable alternative to standard lateral-portal subtalar joint (STJ) arthrodesis without violating sinus or canalis tarsi neurovascular structures. Additionally, those patients who have undergone previous total ankle arthroplasty, arthrodesis, or talonavicular joint arthrodesis may be better served with PASTA over open arthrodesis if STJ fusion becomes necessary. This article describes the unique PASTA surgical procedure and its helpful tips and pearls.
Topics: Humans; Subtalar Joint; Arthroscopy; Arthrodesis; Ankle; Ankle Joint
PubMed: 37236684
DOI: 10.1016/j.cpm.2023.02.002 -
Hand Surgery & Rehabilitation Apr 2023Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's... (Review)
Review
Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.
Topics: Humans; Carpal Bones; Wrist Joint; Wrist; Osteoarthritis; Arthrodesis
PubMed: 36642245
DOI: 10.1016/j.hansur.2022.12.006 -
The Journal of Hand Surgery Aug 2019Four-corner arthrodesis is commonly performed for symptomatic scapholunate advanced collapse and scaphoid nonunion advanced collapse. Potential complications associated... (Review)
Review
Four-corner arthrodesis is commonly performed for symptomatic scapholunate advanced collapse and scaphoid nonunion advanced collapse. Potential complications associated with current techniques include nonunion, hardware issues, and dorsal impingement. A method for achieving 4-corner arthrodesis with strong internal fixation and effective compression while avoiding dorsal and cartilage-bearing surfaces can maximize the benefits of the fusion while minimizing the aforementioned complications. We present a cerclage fusion technique for achieving 4-corner arthrodesis. Proposed benefits of this technique include ease of fixation placement in the coronal plane, inclusion of a large surface area for compression, avoidance of dorsal and cartilage-bearing surfaces, and the ability to adjust sagittal alignment in the midcarpal joint.
Topics: Arthrodesis; Fluoroscopy; Humans; Lunate Bone; Osteoarthritis; Prostheses and Implants; Scaphoid Bone; Wrist Joint
PubMed: 30928022
DOI: 10.1016/j.jhsa.2019.02.016 -
Clinics in Podiatric Medicine and... Jul 2020A malaligned ankle arthrodesis is a painful and complicated pathology. Deformities may be present in the frontal, sagittal, or transverse plane or a combination of... (Review)
Review
A malaligned ankle arthrodesis is a painful and complicated pathology. Deformities may be present in the frontal, sagittal, or transverse plane or a combination of planes. Thorough preoperative evaluation of the deformity and the patient as a whole is crucial to successful revision. Surgical site for revision should be based on center of rotation of angulation, when possible. Revision commonly is performed through opening wedge osteotomy. Closing wedge and focal dome osteotomies, however, are excellent options. Revision also may be performed through external fixation or total ankle replacement. Although the literature is not rich with data, the options discussed provide favorable results.
Topics: Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Bone Malalignment; Fracture Fixation; Humans; Osteotomy; Postoperative Complications; Reoperation
PubMed: 32471613
DOI: 10.1016/j.cpm.2020.03.003 -
Foot and Ankle Clinics Dec 2022Hallux metatarsophalangeal joint (MTPJ) arthrodesis was first described in 1894 by Clutton, who recommended ankylosing the MTPJ to treat painful hallux valgus (HV). He... (Review)
Review
Hallux metatarsophalangeal joint (MTPJ) arthrodesis was first described in 1894 by Clutton, who recommended ankylosing the MTPJ to treat painful hallux valgus (HV). He used ivory pegs to stabilize the MTP joint. Surgeons over the last century have modified the procedure and added indications, including hallux rigidus, rheumatoid arthritis, and revision of failed surgeries. This article addresses many common yet challenging clinical scenarios, and a few hot topics, related to hallux MTPJ arthrodesis, including matarsus primus elevatus, severe hallux valgus, avascular necrosis, and infections. The article provides a condensed evidence-based discussion on how to manage these challenges using MTPJ arthrodesis.
Topics: Male; Humans; Hallux; Hallux Valgus; Hallux Rigidus; Arthrodesis; Metatarsophalangeal Joint; Treatment Outcome
PubMed: 36368794
DOI: 10.1016/j.fcl.2022.07.001 -
The Journal of Foot and Ankle Surgery :... 2022Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the... (Review)
Review
Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the need for hindfoot arthrodesis is generally accepted in severe deformities, there is a debate whether a double or triple arthrodesis should be performed. The aim of our systematic review is to review the fusion rates and mean time to fusion in double and triple arthrodesis. A total of 184 articles were identified using the keyword search through the database of articles published from 2005 to 2017. After review by 3 physicians, a total of 13 articles met the eligibility criteria. The reason for double or triple arthrodesis within the studies were posterior tibial tendon dysfunction, tarsal coalition, degenerative joint disease, osteoarthritis, rheumatoid arthritis, Charcot Marie Tooth, Multiple Sclerosis, Polio, neuromuscular disorder, cerebral palsy, acrodystrophic neuropathy, clubfoot, post-traumatic, and seronegative arthropathy (spondyloarthritis). Within these 13 studies, there were a total of 343 (6-95) subjects extremities operated on. The overall fusion rate for double arthrodesis was 91.75% (289/315) compared to 92.86% (26/28) triple arthrodesis fusion rate, p value .8370. The mean time to fusion for double arthrodesis was 17.96 ± 7.96 weeks compared to 16.70 ± 8.18 weeks for triple arthrodesis, p value = .8133. There are risks associated with triple arthrodesis including increased surgical times, lateral wound complications, residual deformity, surgical costs and peri-articular arthritis. Given the benefits of double arthrodesis over triple arthrodesis and the nearly equivalent fusion rates and time to fusion, double arthrodesis is an effective alternative to triple arthrodesis. The authors of this systematic review recommend double arthrodesis as the hindfoot fusion procedure of choice.
Topics: Arthritis, Rheumatoid; Arthrodesis; Humans; Osteoarthritis; Posterior Tibial Tendon Dysfunction; Tarsal Joints
PubMed: 35221217
DOI: 10.1053/j.jfas.2022.01.012 -
Foot & Ankle International Jan 2022Advances in foot and ankle arthroscopy over the last 2 decades have allowed for subtalar joint arthrodesis to be performed arthroscopically. The potential advantages of...
BACKGROUND
Advances in foot and ankle arthroscopy over the last 2 decades have allowed for subtalar joint arthrodesis to be performed arthroscopically. The potential advantages of the arthroscopic technique include higher fusion rates, lower complications, reduced perioperative morbidity, and accelerated rehabilitation. Arthroscopic arthrodesis may, however, not be appropriate in the setting of complex deformity correction or the need for other open procedures.
METHODS
Surgical techniques of arthroscopic subtalar joint arthrodesis are described. Outcomes and complications associated with these procedures are presented, based on a comprehensive literature review. Thirteen Level IV studies of moderate quality were included.
RESULTS AND CONCLUSION
Excellent arthrodesis union rates were achieved (average 96%, range 86%-100%), at a weighted average union time of 8.8 weeks (95% confidence interval 7.9-9.7). The overall complication rate was 21% (87/415 feet; range 10%-36.4%). Metal irritation was the most common complication (11.2%), followed by nerve injury (4.2%) and infection (0.9%). Similar fusion rates have been reported when comparing arthroscopic and open arthrodesis. Complication rates are also similar, excerpt for infection, which may be lower with arthroscopy. Three different approaches were used to access the subtalar joint with similar union and complication rates. There was no evidence that the use of bone graft or more than 1 screw improved outcomes. The superiority of arthroscopic subtalar fusion over open techniques cannot be demonstrated by the available studies.
LEVEL OF EVIDENCE
Level IV, case series.
Topics: Ankle Joint; Arthrodesis; Arthroscopy; Humans; Retrospective Studies; Subtalar Joint; Treatment Outcome
PubMed: 34549616
DOI: 10.1177/10711007211035397 -
Clinics in Podiatric Medicine and... Oct 2019Lesser digit deformities that require surgical intervention may be corrected by interphalangeal arthrodesis. The traditional fixation device used to stabilize an... (Review)
Review
Lesser digit deformities that require surgical intervention may be corrected by interphalangeal arthrodesis. The traditional fixation device used to stabilize an interphalangeal arthrodesis is a smooth Kirschner wire (K-wire). Its use, however, has been associated with risks. The K-wires are known to migrate and break, and there are increased risks of pin tract infection. Choices for digital implants include nonresorbable, resorbable, and allograft. There are more than 60 newer intramedullary fixation devices available for use in digital surgery. Intramedullary implants also have their own inherent risks. Further research into patient outcomes and cost-effectiveness of these new devices is still needed.
Topics: Arthrodesis; Bone Wires; Humans; Prostheses and Implants; Toe Joint; Toes; Transplantation, Homologous
PubMed: 31466573
DOI: 10.1016/j.cpm.2019.07.001 -
Foot & Ankle International Oct 2022Subtalar arthrodesis is the surgical procedure commonly performed to treat subtalar arthritis. Subtalar arthrodesis may have a higher nonunion rate if there is a...
BACKGROUND
Subtalar arthrodesis is the surgical procedure commonly performed to treat subtalar arthritis. Subtalar arthrodesis may have a higher nonunion rate if there is a preexisting adjacent joint arthrodesis. The aim of this retrospective cohort study was to compare the subtalar arthrodesis union rate of patients with native tibiotalar joints to that of patients with prior tibiotalar arthrodesis. The secondary aim was to assess risk factors for nonunion.
METHODS
A retrospective cohort study of consecutive patients that underwent a subtalar arthrodesis in a single center between 2010 and 2020. The primary outcome of union was determined based on bridging callus on radiographs and clinical symptoms. If there was uncertainty, then a nonweightbearing CT was acquired. Chi-squared test and Mann-Whitney tests compared differences in demographics and risk factors for nonunion between groups. A logistical regression model was performed to determine risk factors for nonunion.
RESULTS
Eighteen patients had an adjacent ankle arthrodesis and 53 patients did not. The successful subtalar arthrodesis union rate in those with a preexisting ankle joint arthrodesis (44.4%) was approximately half that in those without an ankle joint arthrodesis (86.8%) ( < .001). On multivariate logistic regression, an adjacent ankle arthrodesis was the only significant risk factor for nonunion. The odds ratio of nonunion of the subtalar joint with an adjacent ankle arthrodesis present was 4.90 (95% CI 1.02-23.56) compared to a subtalar arthrodesis with a native ankle joint. In addition, 9.4% of patients without an ankle arthrodesis underwent a revision subtalar arthrodesis compared with 44.4% of those with an adjacent ankle arthrodesis ( = .001).
CONCLUSION
In our study, we found that patients undergoing a subtalar arthrodesis with an adjacent ankle arthrodesis have a significantly increased risk of nonunion compared with those undergoing a subtalar arthrodesis with a native ankle. Patients with a previously fused ankle need counseling about the high risk of nonunion and potential additional surgery.
Topics: Ankle; Ankle Joint; Arthrodesis; Humans; Retrospective Studies; Subtalar Joint; Treatment Outcome
PubMed: 35869646
DOI: 10.1177/10711007221110873