title: Outcome After Operative Fusion of the Tarsal Joints: A Systematic Review.
abstract: Arthrodesis of 1 or more joints of the hindfoot is performed to treat severe functional impairment due to pain, deformity, and/or instability. Evaluation of the results of hindfoot arthrodesis from the published data has been difficult owing to the great variety of pathologic entities and surgical techniques reported in the studies. A comprehensive search for relevant reports, reference lists, and citation tracking of the included studies was conducted using the PubMed(®), Embase(®), and CINAHL(®) databases. The studies had to have been prospective, included patients with hindfoot problems, evaluated arthrodesis of 1 or more tarsal joints, and had at least 1 of the following primary clinical outcome parameters: pain, function, or complications. Two of us independently selected the relevant studies using predefined criteria and graded the quality of evidence using a 0 to 9 star scale according to the Newcastle-Ottawa Scale. A total of 16 prospective case series were included; 5 studies scored 6 stars, 8 scored 5 stars, 2 scored 4 stars, and 1 scored 3 stars. A best evidence synthesis was performed, and improvement in function and pain was found for 3 combinations: talonavicular arthrodesis for rheumatoid arthritis, triple arthrodesis for rheumatoid arthritis, and subtalar arthrodesis for post-traumatic arthritis showed good results for pain and function, the last especially when performed arthroscopically. The best evidence syntheses revealed good results for pain and function for these disease-operative technique combinations.
authors.affiliation: Department of Orthopaedics, Maartenskliniek Woerden, Woerden, The Netherlands. Electronic address: m.stegeman@maartenskliniek.nl.
authors.forename: Mark
authors.initials: M
authors.lastname: Stegeman
authors.affiliation: Department of Orthopaedics, Sint Maartenskliniek Nijmegen, Nijmegen, The Netherlands.
authors.forename: Jan Willem Karel
authors.initials: JW
authors.lastname: Louwerens
authors.affiliation: Department of Orthopaedics, Maartenskliniek Woerden, Woerden, The Netherlands.
authors.forename: Jan Ton
authors.initials: JT
authors.lastname: van der Woude
authors.affiliation: Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Wilhelmus Cornelis Hermina
authors.initials: WC
authors.lastname: Jacobs
authors.affiliation: Department of Orthopaedics and Rheumatology, Maartenskliniek Woerden, Woerden, The Netherlands.
authors.forename: Berbke To Josephine
authors.initials: BT
authors.lastname: van Ginneken
mesh_terms: D001168:Arthritis / Q000601:surgery; D001174:Arthrodesis; D004185:Disability Evaluation; D005413:Flatfoot / Q000601:surgery; D006801:Humans; D010146:Pain / Q000209:etiology / Q000601:surgery; D013640:Tarsal Joints / Q000601:surgery*; D064232:Visual Analog Scale
keywords: Newcastle-Ottawa score; arthrodesis; best evidence synthesis; hindfoot; outcome scores