Does a fibula-sparing approach improve outcomes in tibiotalocalcaneal arthrodesis? |
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| Institution: | 1. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA;2. Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA;3. Departmnt of Orthopaedic Surgery, Loyola University Medical Center, Burr Ridge, IL, USA;4. Department of Traumatology and Orthopedics, University of the Andes Clinic, Las Condes, Chile;1. Department of Pediatric Orthopaedics, Schulthess Klinik, Zürich, Switzerland;2. Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland;1. Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran;2. Students'' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran;3. Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran;4. Rothman Orthopaedics Florida at AdventHealth, Orlando, FL, USA;5. Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;1. Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen 518000, Guangdong Province, China;2. Shenzhen Second People’s Hospital, Shenzhen 518000, Guangdong Province, China;1. Foot & Ankle Research and Innovation Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA;2. Department of Orthopaedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands;3. Harvard Combined Orthopaedic Residency Program, Boston, MA, USA;4. Department of Orthopedic Surgery, Faculty of Medicine, Chiang Mai University, Thailand;5. Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA;6. Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA |
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| Abstract: | BackgroundTibiotalocalcaneal (TTC) arthrodesis is considered a salvage procedure for either complex deformity or arthritis about the hindfoot, and can be performed via fibula-resection (FR) or fibula-sparing (FS) approaches. The primary aim of this study was to investigate differences in outcomes in FR versus FS TTC arthrodeses.MethodsThis was a retrospective cohort study reviewing outcomes of TTC arthrodesis at a single institution. Patients who underwent a TTC arthrodesis from 2005 to 2017 and had minimum two-year follow-up were included. Preoperative diagnosis, pre- and post-operative radiographic coronal alignment, fixation methods, and complications were compared between groups.Results107 patients (110 ankles) underwent TTC arthrodesis, with a mean age of 57.0 years (sd, 14.0 years). The mean clinical follow-up was 50.7 months (range, 24–146) and mean radiographic follow-up was 45.8 months (range, 6–146 months). Pre-operative diagnoses included arthritis (N = 40), prior non-union (N = 21), Charcot neuro-arthropathy (N = 15), failed total ankle arthroplasty (N = 15) and avascular necrosis of the talus (N = 19). Sixty-nine ankles comprised the FS group and 41 comprised the FR group. There was no significant difference in the non-union rate between groups (29% FR vs 38% FS, p = 0.37), complication rate (59% FR vs 64% FS, p = 0.59), or post-operative coronal standing radiographic alignment (89.6 degrees FR, 90.5 degrees FS, p = 0.26). Logistic regression analyses demonstrated a pre-operative diagnosis of failed TAA was associated with post-operative nonunion (OR:3.41,CI:1.13–11.04,p = 0.03). Pre-operative indication for TTC arthrodesis of arthritis alone was associated with a decreased risk of non-union (OR:0.27,CI:0.11–0.62,p = 0.002).ConclusionTTC arthrodesis is a successful surgical option for complex hindfoot deformity, arthritis, and limb salvage regardless of surgical approach. We did not detect a difference in the union rate, incidence of complications, or coronal plane radiographic alignment in fibula-sparing versus fibula-resection constructs. Patients with a pre-operative indication for surgery of arthritis may be at decreased risk of developing non-union.Level of evidenceIII – Retrospective cohort study |
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| Keywords: | Arthritis TTC fusion Tibiotalocalcaneal arthrodesis |
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