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Updated: Jul 4, 2026

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Subtalar distraction arthrodesis using interpositional frozen structural allograft.

David N Garras1, James R Santangelo, David W Wang

  • 1Duke Health Center, 3116 N Duke Street, Durham, NC 27704, USA.

Foot & Ankle International
|June 14, 2008
PubMed
Summary

Structural allograft is a viable alternative for subtalar arthrodesis, offering favorable outcomes comparable to autograft. This study shows good union rates and improved patient function with allograft use.

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Area of Science:

  • Orthopedic surgery
  • Bone grafting techniques
  • Foot and ankle reconstruction

Background:

  • Subtalar bone-block distraction arthrodesis with autograft has donor site morbidity.
  • Structural allograft is emerging as a potential alternative for subtalar arthrodesis.
  • This study investigates the use of interpositional structural allograft for subtalar distraction arthrodesis.

Purpose of the Study:

  • To evaluate the clinical and radiographic outcomes of subtalar distraction arthrodesis using structural allograft.
  • To compare the efficacy of structural allograft to historical autograft data.
  • To assess the union rates and functional improvements following allograft subtalar arthrodesis.

Main Methods:

  • Prospective case series of 22 patients (24 feet) undergoing subtalar arthrodesis with fresh-frozen femoral head structural allograft.

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  • Indications included subtalar arthrosis, heel height loss, and anterior ankle impingement.
  • Clinical outcomes assessed using the AOFAS ankle-hindfoot score; union determined by radiographic evidence.

    • Main Results:

    • 90% union rate (19/21 feet) at a mean of 15.5 weeks.
    • Mean AOFAS score improved significantly from 21 to 71 points (p < 0.05).
    • Complications included nonunion (2), malalignment (1), impingement (1), neuralgia (1), and hardware issues (2); nonunions linked to tobacco use.

    Conclusions:

    • Subtalar arthrodesis with interpositional structural allograft yields favorable clinical and radiographic outcomes.
    • Restoration of hindfoot function and dimensions with allograft is comparable to structural autograft.
    • Structural allograft presents a promising alternative to autograft, potentially reducing donor site morbidity.