Overview of subtalar arthrodesis techniques: Options, pitfalls and solutions

Tuijthof, Gabriëlle J.M.; Beimers, Lijkele; Kerkhoffs, Gino M.M.J.; Dankelman, Jenny; Dijk, C. Niek van

doi:10.1016/j.fas.2009.07.002

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Volume 16, Issue 3 , Pages 107-116, September 2010

Overview of subtalar arthrodesis techniques: Options, pitfalls and solutions

Gabriëlle J.M. Tuijthof, Phd
- Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Materials and Maritime Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
- Corresponding author at: Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 205662173; fax: +31 205669117.
Lijkele Beimers, MD
- Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Gino M.M.J. Kerkhoffs, Phd
- Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Jenny Dankelman, PhD (Professor)
- Department of Biomechanical Engineering, Faculty of Mechanical, Materials and Maritime Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
C. Niek van Dijk, MD, PhD (Professor)
- Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Received 13 February 2009; received in revised form 20 July 2009; accepted 24 July 2009. published online 28 August 2009.

Abstract

Background

Subtalar arthrodesis (SA) is the preferred treatment for painful isolated subtalar disease. Although results are generally favourable, analysis of current operative techniques will help optimizing this treatment. The aim was to give an overview of SA-techniques and their pitfalls. Possible solutions were identified.

Materials and methods

A literature search was performed for papers that presented SA operative techniques. The general technique was divided into phases: surgical approach, cartilage removal, bone graft selection, hindfoot deformity correction and fixation.

Results

The published series were invariably retrospective reviews of small heterogenous groups of different hindfoot pathologies. The weighted outcome rate for SA was 85% (68–100%) performed in 766 feet and for SA requiring correction of malalignment 65% (36–96%) in 1001 feet. Non-union (weighted percentage 12%), malalignment (18%), and screw removal (17%) were the prevailing late complications.

Pitfalls

The following pitfalls were identified: 1) early complications related to the incisions made in open approaches, 2) insufficient cartilage removal, improper bone graft selection and fixation techniques, all possibly leading to non-union, 3) morbidity caused by bone graft harvesting and secondary screw removal, 4) under- or overcorrection of the hindfoot possibly due to improper intraoperative verification and 5) inadequate assessment of bony fusion.

Solutions

The review provides solutions to possibly overcome some pitfalls: 1) if applicable use an arthroscopic approach in combination with distraction devices and new burrs, 2) if possible use local bone graft or allografts, 3) use two screws for fixation to prevent rotational micromotion, and 4) improve assessment of operative outcome by application of appropriate assessment of bony fusion and alignment.