Comparative Nonunion Rates in Triple Arthrodesis

The contemporary literature is unclear regarding the joint that is most "at risk" to yield a nonunion in the performance of triple arthrodesis of the foot. There is also a debate regarding the best methods of joint preparation. A retrospective radiographic review was conducted of all primary triple arthrodeses performed within in a Northern California health maintenance organization between January 2007 and June 2013. Data documenting joint preparation techniques were collected, and postoperative imaging was reviewed to measure time to osseous union. Patient demographics were also collected. One hundred fifty-two patients (157 procedures) met the inclusion criteria. The overall nonunion rate for triple arthrodesis in this series was 29.9% (47/157). The nonunion rate of the talonavicular joint was 20.4% (32/157); the nonunion rate of the calcaneocuboid joint was 17.2% (27/157); and the nonunion rate of the subtalar joint was 8.9% (14/157). In conclusion, we found the most likely joint to obtain nonunion during triple arthrodesis was the talonavicular joint. Furthermore, the most efficacious joint preparation technique was a combination joint resection or curettage with fish scaling.