title: Early results of a novel technique: Hindfoot fusion in talus osteonecrosis prior to ankle arthroplasty: A case series.
abstract: BACKGROUND
  The purpose of this study was to evaluate the clinical outcome of a two staged approach of subtalar arthrodesis followed by TAR for patients with ankle arthritis and AVN talus.
  
  
  METHODS
  Out of total 210 TARs performed at our institute; 7 patients underwent a two staged procedure between 2006 and 2010. All patients had over 3 years of follow up (except one). The clinical results were assessed using AOFAS, WOMAC, SF-36 and patient satisfaction scores.
  
  
  RESULTS
  The mean follow up was 3 years. There was significant improvement in AOFAS and WOMAC (pain and stiffness) from pre-op to 3 years post-op (P<0.05). SF 36 scores improved from pre-op to 3 years post-op for 6/8 domains. 5 patients were satisfied at 3 years for overall surgical outcomes, 4 were satisfied with pain relief. Radiological signs of talar subsidence were noted in 2 patients at year 1. This did not progress at 3 years and did not deteriorate clinical outcome.
  
  
  CONCLUSIONS
  We recommend our two staged approach to deal with this difficult clinical problem. We believe this approach is safe for TAR surgery where talar vascularity and bone quality is questionable leading to reduced talar subsidence, ischaemic pain and improvement in longevity of TAR.
  
  
  METHODS
  Evidence IV (Retrospective case series).
authors.affiliation: Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, NE7 7DN, United Kingdom. Electronic address: devaliak@gmail.com.
authors.forename: Kailash L
authors.initials: KL
authors.lastname: Devalia
authors.affiliation: Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, NE7 7DN, United Kingdom. Electronic address: jayasree.ramaskandhan@nuth.nhs.uk.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Ramaskandhan
authors.affiliation: Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, NE7 7DN, United Kingdom. Electronic address: K.Muthumayandi@kent.ac.uk.
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Muthumayandi
authors.affiliation: Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, NE7 7DN, United Kingdom. Electronic address: Malik.Siddique@nuth.nhs.uk.
authors.forename: Malik
authors.initials: M
authors.lastname: Siddique
mesh_terms: D000368:Aged; D000842:Ankle / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods; D058737:Arthroplasty, Replacement, Ankle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013628:Talus / Q000601:surgery*; D013997:Time Factors
keywords: Ankle arthroplasty; Avascular necrosis of talus; Osteonecrosis; Subtalar arthrodesis; Talar collapse; Talar subsidence; Total ankle replacement