Triple arthrodesis through a single lateral approach: a cadaveric experiment

Area of Science:

• Orthopedic Surgery
• Anatomy
• Surgical Technique

Background:

• Triple arthrodesis is a surgical procedure to fuse three major joints in the hindfoot.
• A single lateral approach aims to simplify this complex surgery.
• Challenges exist in achieving complete fusion, particularly at the talonavicular joint.

Purpose of the Study:

• To evaluate the efficacy and complications of a single lateral approach for triple arthrodesis.
• To assess the degree of cartilage and bone removal in the talocalcaneal, talonavicular, and calcaneocuboid joints.
• To identify anatomical challenges and suggest improvements for the talonavicular joint fusion.

Main Methods:

• Six cadaveric feet underwent triple arthrodesis via a single lateral approach.
• Joint obliteration was attempted for talocalcaneal, talonavicular, and calcaneocuboid joints.
• Post-procedure inspection assessed cartilage and bone removal, with specific attention to the talonavicular joint.

Main Results:

• Calcaneocuboid joint: 90% cartilage removal.
• Talocalcaneal joint: 80% cartilage removal.
• Talonavicular joint: only 38% cartilage removal, with noted anatomical difficulties and complications like inadvertent talar neck/head division.

Conclusions:

• The single lateral approach for triple arthrodesis is not recommended due to significant difficulties and complications, especially with the talonavicular joint.
• An auxiliary medial incision is advised for approaching the talonavicular joint to improve fusion rates.
• Anatomy laboratory experience is valuable for learning complex surgical procedures like triple arthrodesis.