title: Is Subtalar Joint Cartilage Resection Necessary for Tibiotalocalcaneal Arthrodesis via Intramedullary Nail? A Multicenter Evaluation.
abstract: Tibiotalocalcaneal arthrodesis with intramedullary nailing is traditionally performed with formal preparation of both the subtalar and ankle joints. However, we believe that subtalar joint preparation is not necessary to achieve satisfactory outcomes in patients undergoing tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. The primary aim of the present retrospective study was to evaluate the outcomes of patients who had undergone tibiotalocalcaneal arthrodesis with an intramedullary nail without formal subtalar joint cartilage resection. A multicenter medical record review was performed to identify consecutive patients. Pain was assessed using a visual analog scale, and osseous union at the tibiotalar joint was defined as bony trabeculation across the arthrodesis site on all 3 radiographic views. Progression of joint deterioration was evaluated across time at the subtalar joint, using a modified grading system developed by Takakura et al. Forty consecutive patients (aged 61.9 ± 12.9 years; 17 men) met the inclusion and exclusion criteria. Compared with the pain reported preoperatively (6.4 ± 2.7), a statistically significant decline was seen in the pain experienced after surgery (1.2 ± 1.8; p < .001). The mean time to consolidated arthrodesis at the ankle joint was 3.8 ± 1.5 months. A statistically significant increase in deterioration at the subtalar joint was observed across time [t(36) = -6.200, p < .001]. Compared with previously published data of subtalar joint cartilage resection, the present study has demonstrated a similar decline in pain, with a high rate of union, and also a decrease in operative time when preparation of the subtalar joint was not performed.
authors.affiliation: Associate Physician, Martin Foot and Ankle, York, PA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mulhern
authors.affiliation: Research Associate, Coordinated Health, Allentown, PA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Protzman
authors.affiliation: Fellow, Foot & Ankle Reconstruction, Aria 3B Orthopaedic Specialists Philadelphia, PA.
authors.forename: Maxwell J
authors.initials: MJ
authors.lastname: Levene
authors.affiliation: Resident, Carilion Clinic, Roanoke, VA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Martin
authors.affiliation: Fellowship Director, Foot & Ankle Reconstruction, Aria 3B Orthopaedic Specialists, Philadelphia, PA.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Fleming
authors.affiliation: Assistant Professor, Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA; Co-Section Chief, Foot and Ankle, Virginia Tech Carilion School of Medicine, Carillion Clinic, Roanoke, VA.
authors.forename: J Randolph
authors.initials: JR
authors.lastname: Clements
authors.affiliation: Fellowship Director, Foot & Ankle Reconstruction, and Department Chair, Foot and Ankle Department, Coordinated Health, Bethlehem, PA; Clinical Professor of Surgery, Clinical Sciences Department, The Commonwealth Medical College, Scranton, PA. Electronic address: drsbrigido@mac.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brigido
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D002358:Cartilage, Articular / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: arthrodesis; end-stage osteoarthritis; intramedullary nail; pantalar; subtalar joint