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Isolated subtalar arthrodesis.

M E Easley1, H J Trnka, L C Schon

  • 1Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA.

The Journal of Bone and Joint Surgery. American Volume
|May 20, 2000
PubMed
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This study on isolated subtalar arthrodesis found lower union rates than previously reported, with smoking and avascular bone significantly impacting outcomes. Identifying these factors can improve surgical success in adult foot and ankle reconstructions.

Area of Science:

  • Orthopedic Surgery
  • Foot and Ankle Surgery
  • Arthrodesis Procedures

Background:

  • Retrospective review of isolated subtalar arthrodesis in adults.
  • Investigated factors influencing union rates and overall outcomes.
  • Hypothesized lower-than-reported union and higher complication rates.

Purpose of the Study:

  • To review outcomes of isolated subtalar arthrodesis in adults.
  • To identify factors affecting the union rate of subtalar fusions.
  • To compare current findings with previous literature on subtalar arthrodesis.

Main Methods:

  • 184 isolated subtalar arthrodeses in 174 adults (1988-1995).
  • Indications included post-traumatic arthritis, primary arthritis, failed previous arthrodesis, and congenital deformity.

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  • Rigid internal fixation with bone graft (autograft or allograft) used in most cases.

    • Main Results:

    • Overall union rate was 84% (154/184), with lower rates for revision (71%) and smokers (73%).
    • Presence of >2mm avascular bone at the site was associated with all nonunions (p<0.05).
    • Complications included hardware prominence (20%), lateral impingement (10%), and malalignment (3-3%).

    Conclusions:

    • Isolated subtalar arthrodesis outcomes may not be as favorable as previously reported.
    • Smoking, significant avascular bone, and prior failed arthrodesis negatively impact union rates.
    • Optimizing surgical technique and patient selection can potentially improve subtalar fusion success.