Foot & Ankle International - July 2016 - (Page 696)
642751
FAIXXX10.1177/1071100716642751Foot & Ankle InternationalUsuelli et al
research-article2016
Article
Clinical Outcome and Fusion Rate
Following Simultaneous Subtalar Fusion
and Total Ankle Arthroplasty
Foot & Ankle International®
2016, Vol. 37(7) 696-702
© The Author(s) 2016
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DOI: 10.1177/1071100716642751
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Federico G. Usuelli, MD1, Camilla Maccario, MD1,2, Luigi Manzi, MD1,3,
and Christopher Edward Gross, MD4
Abstract
Background: Patients with arthritis or severe dysfunction involving both the ankle and subtalar joints can benefit from
tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. TTC fusion is considered by many
as a salvage operation resulting in a stiff ankle and hindfoot, considerably limiting global foot function. With the evolution
of prosthetic design and operative techniques, total ankle replacement (TAR) has become a reasonable alternative to
arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint in patients simultaneously treated
with total ankle replacement (TAR) and subtalar joint fusion.
Methods: This study included 25 patients who underwent primary TAR and simultaneous subtalar fusion between May
2011 and November 2014. Sixteen males (64%) and 9 females (36%) were enrolled with a mean age of 58 years (25-82).
Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2 ±
11.6 months. Radiographic examination included a postoperative computed tomographic (CT) scan obtained 12 months
after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional
scores were also assessed.
Results: At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar
fusion was 92%. There was a statistically significant increase in American Orthopaedic Foot & Ankle Society ankle/hindfoot
score from 27.9 to 75.1. Ankle range of motion significantly increased from 12 to 32.8 degrees. Additionally, there was a
statistically significant decrease in visual analog scale pain score from 8.6 to 2.1.
Conclusions: TAR and simultaneous subtalar joint fusion were reliable procedures for the treatment of ankle and subtalar
joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopedic surgeons in determining the
degree of successful fusion of subtalar arthrodesis.
Level of Evidence: Level IV, case series.
Keywords: ankle, replacement, subtalar, subtalar arthrodesis, fusion, ankle replacement, computed tomography
Introduction
Subtalar arthrodesis is commonly performed for management of posttraumatic subtalar arthritis, rheumatoid arthritis, posterior tibial tendon dysfunction, tarsal coalition, and
primary subtalar arthritis, with a reported fusion rate ranging from 84% to 100%.* Several studies have noted that
fusion is often required following the progression of subtalar arthritis after ipsilateral tibiotalar arthrodesis.3,10,28 In
these patients, the altered loading and reduced talar blood
supply can create a less favorable environment for the subtalar fusion resulting in a fusion rate of 61.5% to 66.7%.18,41
Patients with arthritis or severe dysfunction involving
both the ankle and the subtalar joints can benefit
*References 1, 4, 14, 16-18, 20, 26, 31, 35
from tibiotalocalcaneal (TTC) arthrodesis or total ankle
replacement and subtalar fusion.9,25,33,38 TTC fusion is considered by many a salvage operation for failed previous surgery or Charcot neuroarthropathy, resulting in a rigid ankle
and hindfoot, considerably limiting global foot function.34
Moreover, fusion is associated with complications such as
1
USPeC, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Universita' degli Studi di Milano, Milan, Italy
3
Seconda Università degli Studi di Napoli, Napoli, Italy
4
Department of Orthopaedics, Medical University of South Carolina,
Charleston, South Carolina, USA
2
Corresponding Author:
Federico G. Usuelli, MD, USPeC, IRCCS Istituto Ortopedico Galeazzi,
Via Riccardo Galeazzi 4, 20161 Milan, Italy.
Email: fusuelli@gmail.com
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Table of Contents for the Digital Edition of Foot & Ankle International - July 2016
TOC/TOC/Verso
Editorial Board
Advertiser Index
Long Term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction
Clinical Outcome and Fusion Rate following Simultaneous Subtalar Fusion and Total Ankle Arthoplasty
Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty
Secondary Arthrodesis After Total Ankle Arthroplasty
Functional Outcomes Following First Metatarsophalangeal Arthrodesis
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Pain Threshold Tests in Patients With Heel Pain Syndrome
Long-term Results of Chronic Achilles Tendon Ruptures With V-Y Tendon Plasty and Fascia Turndown
Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle
Incisura Morphology as a Risk Factor for Syndesmotic Malreduction
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia
Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia: A Prospective Study of 78 Cases.
Response to "Letter Regarding: Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia"
The Internal Brace for Midsubstance Achilles Ruptures
The Evolution of Patient Safety
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