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Surgical treatment of hindfoot inflammatory diseases: 107 arthrodesis.
Orthop Traumatol Surg Res. 2012 Oct; 98(6 Suppl):S85-90.OT

Abstract

INTRODUCTION

In rheumatoid diseases, hindfoot arthrodesis abolishes pain and corrects deformity. The choice between selective and double arthrodesis depends on whether the hindfoot malalignment is fixed or not. Indications for surgery are well codified. The various types of arthrodesis have never been assessed together on a large series. We here report a series that is substantial in numbers and in follow-up.

MATERIALS AND METHODS

A continuous single-center retrospective study included patients with native hindfoot inflammatory disease treated by arthrodesis between 1996 and 2009.

RESULTS

Around 80% of patients were followed up, for a mean 7 years. Fifty-four isolated talonavicular arthrodeses, 14 talocalcaneal arthrodeses and 39 double arthrodeses were performed. 96% of patients had rheumatoid arthritis and 4% spondylarthritis. 62% were completely pain-free at follow-up. The satisfaction rate was 91% and mean AOFAS score 70%. 6% of patients showed symptomatic non-union, mainly associated with talonavicular arthrodesis. In 22% of double arthrodeses and 11% of talonavicular arthrodeses, ankle status required surgical revision. In double arthrodesis, there was no correlation between hindfoot deviation and secondary deterioration in ankle status. Talocalcaneal arthrodesis was associated with radiologic hindfoot varus, both preoperatively and at follow-up.

DISCUSSION

Non-union was the main complication in talonavicular arthrodesis. The rate of secondary ankle surgery was significantly elevated in double arthrodesis. These findings support Suckel's cadaver studies, which, in 2007, reported early deterioration in ankle status in double arthrodesis, due to mechanical overloading. Talocalcaneal arthrodesis proved reliable and simple, free of major complications and with a 100% satisfaction rate.

CONCLUSION

Double arthrodesis showed the greatest benefit in terms of restoring foot architecture, but was associated with a higher rate of deterioration in ankle status. Preventive double arthrodesis is not recommended in case of isolated arthritis with reducible hindfoot malalignment.

Authors+Show Affiliations

Hip, Knee and Foot Surgery Medical Unit, Lapeyronie University Hospital (Montpellier-1 University), 271, avenue Doyen-Gaston-Giraud, 34000 Montpellier, France. marieaudemunoz@yahoo.frNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22939106

Citation

Munoz, M A., et al. "Surgical Treatment of Hindfoot Inflammatory Diseases: 107 Arthrodesis." Orthopaedics & Traumatology, Surgery & Research : OTSR, vol. 98, no. 6 Suppl, 2012, pp. S85-90.
Munoz MA, Augoyard R, Canovas F, et al. Surgical treatment of hindfoot inflammatory diseases: 107 arthrodesis. Orthop Traumatol Surg Res. 2012;98(6 Suppl):S85-90.
Munoz, M. A., Augoyard, R., & Canovas, F. (2012). Surgical treatment of hindfoot inflammatory diseases: 107 arthrodesis. Orthopaedics & Traumatology, Surgery & Research : OTSR, 98(6 Suppl), S85-90. https://doi.org/10.1016/j.otsr.2012.06.006
Munoz MA, et al. Surgical Treatment of Hindfoot Inflammatory Diseases: 107 Arthrodesis. Orthop Traumatol Surg Res. 2012;98(6 Suppl):S85-90. PubMed PMID: 22939106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of hindfoot inflammatory diseases: 107 arthrodesis. AU - Munoz,M A, AU - Augoyard,R, AU - Canovas,F, AU - ,, Y1 - 2012/08/28/ PY - 2012/03/27/received PY - 2012/06/29/accepted PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/3/19/medline SP - S85 EP - 90 JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res VL - 98 IS - 6 Suppl N2 - INTRODUCTION: In rheumatoid diseases, hindfoot arthrodesis abolishes pain and corrects deformity. The choice between selective and double arthrodesis depends on whether the hindfoot malalignment is fixed or not. Indications for surgery are well codified. The various types of arthrodesis have never been assessed together on a large series. We here report a series that is substantial in numbers and in follow-up. MATERIALS AND METHODS: A continuous single-center retrospective study included patients with native hindfoot inflammatory disease treated by arthrodesis between 1996 and 2009. RESULTS: Around 80% of patients were followed up, for a mean 7 years. Fifty-four isolated talonavicular arthrodeses, 14 talocalcaneal arthrodeses and 39 double arthrodeses were performed. 96% of patients had rheumatoid arthritis and 4% spondylarthritis. 62% were completely pain-free at follow-up. The satisfaction rate was 91% and mean AOFAS score 70%. 6% of patients showed symptomatic non-union, mainly associated with talonavicular arthrodesis. In 22% of double arthrodeses and 11% of talonavicular arthrodeses, ankle status required surgical revision. In double arthrodesis, there was no correlation between hindfoot deviation and secondary deterioration in ankle status. Talocalcaneal arthrodesis was associated with radiologic hindfoot varus, both preoperatively and at follow-up. DISCUSSION: Non-union was the main complication in talonavicular arthrodesis. The rate of secondary ankle surgery was significantly elevated in double arthrodesis. These findings support Suckel's cadaver studies, which, in 2007, reported early deterioration in ankle status in double arthrodesis, due to mechanical overloading. Talocalcaneal arthrodesis proved reliable and simple, free of major complications and with a 100% satisfaction rate. CONCLUSION: Double arthrodesis showed the greatest benefit in terms of restoring foot architecture, but was associated with a higher rate of deterioration in ankle status. Preventive double arthrodesis is not recommended in case of isolated arthritis with reducible hindfoot malalignment. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/22939106/Surgical_treatment_of_hindfoot_inflammatory_diseases:_107_arthrodesis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0568(12)00132-6 DB - PRIME DP - Unbound Medicine ER -