title: Talonavicular arthrodesis or triple arthrodesis: peak pressure in the adjacent joints measured in 8 cadaver specimens.
abstract: BACKGROUND
  Talonavicular arthrodesis is a differential indication for triple arthrodesis. Differences regarding intraarticular pressure loads on the adjacent joints have not been investigated to date, but they are of clinical relevance when considering long-term joint degeneration.
  
  
  METHODS
  We used a dynamic foot model to measure intraarticular peak pressures with electronic sensors in 8 anatomical specimens in different areas of the ankle joint and in the naviculocuneiform joint. Force was applied to extrinsic tendons via cables attached to computer- regulated hydraulic cylinders. A ground reaction force was simulated in a tilting angle- and force-controlled translation stage.
  
  
  RESULTS
  We measured significantly higher peak pressures in the ankle joint after triple arthrodesis (5.7 Mpa) than after talonavicular arthrodesis (5.2 Mpa), with differences especially in the anterior section (5.2 Mpa as compared to 4.6 Mpa). Centrally, the peak pressure was similar, at 4.6 MPa and 4.5 Mpa, respectively. In the posterior area, the peak pressure after triple arthrodesis was lower (4.1 MPa as opposed to 4.4 Mpa). After triple arthrodeses, we measured higher values laterally/medially in the ankle joint (5.5 MPa/4.6 Mpa) than after talonavicular arthrodesis (5.1 MPa/4.4 Mpa). In the naviculocuneiform joint, we again saw higher peak pressures after triple arthrodesis than after talonavicular arthrodesis.
  
  
  CONCLUSIONS
  Our findings from this cadaver study indicate a lower and more evenly distributed peak pressure load in the ankle joint after talonavicular arthrodesis than after triple arthrodesis; thus, mechanically, a selective arthrodesis appears to be more favorable. In contrast, triple arthrodesis leads to an increase in peak pressure in the ankle joint, which may in turn lead to joint degeneration.
authors.affiliation: Orthopedics Department, Tuebingen University Hospital, Tuebingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Suckel
authors.forename: Otto
authors.initials: O
authors.lastname: Muller
authors.forename: Tina
authors.initials: T
authors.lastname: Herberts
authors.forename: Peter
authors.initials: P
authors.lastname: Langenstein
authors.forename: Patrik
authors.initials: P
authors.lastname: Reize
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Wulker
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D008954:Models, Biological; D011312:Pressure; D016059:Range of Motion, Articular; D013380:Subtalar Joint / Q000503:physiopathology / Q000601:surgery*