Outcomes and Complications After Open Versus Posterior Arthroscopic Subtalar Arthrodesis in 121 Patients.
BACKGROUND
Subtalar arthrodesis is a standard treatment for subtalar arthritis. Both open and arthroscopic techniques have been described and are commonly used. The cases of a consecutive series of 121 patients treated with either open or posterior arthroscopic techniques are presented with functional outcomes and complications.


METHODS
A retrospective chart review with prospectively collected data was performed for 121 consecutive patients (129 feet) who underwent subtalar arthrodesis with open (60 feet in 57 patients) or arthroscopic (69 feet in 64 patients) techniques between 2001 and 2014. The technique was selected on the basis of the deformity and surgeon preference. The primary outcomes were the visual analog scale (VAS) for pain, Short Form (SF)-36, Foot Function Index (FFI), and Angus and Cowell rating scores. Secondary outcomes included hindfoot alignment, operative time, length of hospital stay, fusion rate, time to return to work, ability to perform sports and activities of daily living, and complications.


RESULTS
Both groups demonstrated significant improvement in VAS, SF-36, FFI, and Angus and Cowell rating scale scores. The mean operative time, VAS score, Angus and Cowell rating score, and coronal plane hindfoot alignment were similar between the groups. There were no significant differences within the groups with respect to union rate and time to union among the various sizes of screws and types of bone graft. Sural nerve complications and a painful surgical scar were more frequent in the open group, whereas hardware-related symptoms were more frequent in the arthroscopically treated group.


CONCLUSIONS
Subtalar arthrodesis performed with open and arthroscopically assisted techniques demonstrated signiﬁcant improvement in terms of pain and function as measured with the VAS, FFI, and SF-36. While the time to union and to return to work, activities of daily living, and sports activities were significantly shorter for the arthroscopic arthrodesis group, the union rates and complications overall were not significantly different.


METHODS
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand chamnanni@yahoo.com.
Chamnanni
C
Rungprai
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Phinit
P
Phisitkul
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
John E
JE
Femino
Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, Colorado.
Kevin D
KD
Martin
Department of Orthopaedic Surgery, University of Utah Health Care - Hospitals and Clinics, Salt Lake City, Utah.
Charles L
CL
Saltzman
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Annunziato
A
Amendola
D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013380:Subtalar Joint / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult