Salvage of avascular necrosis of the talus by combined ankle and hindfoot arthrodesis without structural bone graft.
BACKGROUND
Osteonecrosis of the talus is a well-recognized pathology, which can result in significant hindfoot collapse resulting in poor function and pain. Treatment with intramedullary tibiotalocalcaneal arthrodesis (IMTCA) using a retrograde intramedullary nail is widely utilized for severe concomitant tibiotalar and subtalar pathologies. This study reports the results of ankle and hindfoot arthrodesis in patients with arthritis and deformity caused specifically by talar osteonecrosis.


METHODS
Fourteen ankle and hindfoot arthrodeses with retrograde intramedullary nail were studied, with a mean follow-up of 26 months. Medical records were reviewed for operative technique, concomitant procedures, bone graft used, and postoperative complications including nonunion, infection, nerve injury, wound healing issues, and the need for additional surgeries. Clinical outcomes included Visual Analogue Scale for pain, the AOFAS Ankle/Hindfoot Score, and the SF-36 questionnaire.


RESULTS
Over 80% of cases had osteonecrosis involving the entire body of the talus. In 4 cases tibiocalcaneal arthrodesis was performed, with the remaining talar head-neck portion fused to anterior aspect of tibia. Union was achieved in all cases. The mean preoperative VAS score was 6.9 (range 5 to 9, SD ± 1.5) decreasing to 1.7 (range 0 to 6, SD ± 2.2) postoperatively (P = .00008). The mean preoperative AOFAS score was 32.7 (range 20 to 46, SD ± 8.7), increasing to 72.1 (range 46 to 86, SD ± 10.1, P = .00003). The mean preoperative SF-36 physical component score was 30.5 (range 21 to 42, SD ± 6.9) increasing to 42.8 (range 20 to 60, SD ± 11.4) postoperatively (P = .02). Complications included 1 stress fracture, 4 hardware removals, and 1 superficial infection.


CONCLUSIONS
Ankle and hindfoot arthrosis due to extensive talar AVN can be successfully treated with IMTCA.
Baylor University Medical Center, Dallas, TX, USA Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Shay
S
Tenenbaum
Baylor University Medical Center, Dallas, TX, USA.
Kristopher G
KG
Stockton
Department of Orthopedics, Emory University School Medicine, Atlanta, GA, USA.
Jason T
JT
Bariteau
Baylor University Medical Center, Dallas, TX, USA james.brodsky@baylorhealth.edu.
James W
JW
Brodsky
D000328:Adult; D000368:Aged; D000842:Ankle / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D016025:Bone Transplantation; D005260:Female; D005528:Foot / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000601:surgery*; D012189:Retrospective Studies; D013628:Talus / Q000601:surgery*
arthrodesis; avascular necrosis; fusion; hindfoot; osteonecrosis; retrograde intramedullary nail; talus; tibiocalcaneal; tibiotalocalcaneal