Objective: To evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and effect of the use of different types of autologous bone grafts. Methods: This was a retrospective study with radiological evaluation of patients with subtalar arthrosis who underwent primary arthrodesis at a reference hospital between January 2008 and December 2014. Patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years (range: 19-74 years) were evaluated, among whom 90 (40%) were smokers and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was due to sequelae of calcaneal fractures. A bone graft was used in 65 (27.7%) patients. The overall union rate was 85.4%, and 14.6% of the patients progressed to pseudoarthrosis. A statistically significant difference was found in the nonunion rate in smokers (p-value=0.015 by chi-square test), especially in those who did not receive a bone graft (p-value=0.014 by chi-square test). However, no significant difference was found between smokers who received a bone graft and those who did not (p-value=0.072 by chi-square test). The union rate was related to the donor site, with pseudoarthrosis in 33.3% of surgeries with an autologous calcaneal bone graft (p-value=0.011). Conclusion: Smoking increased the likelihood of pseudoarthrosis in subtalar arthrodesis by 2.5-fold, and pseudoarthrosis is related to the autologous bone graft donor site. Level of Evidence III; Therapeutic studies; Comparative Retrospective Study.
Introduction: The bone graft is an important component of foot and ankle arthrodesis and is used in conditions in which the biological system is known to be unfavorable and scraping the joint will cause a considerable structural defect. The objective was to evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and to determine the effect of the use of different types of bone autografts. Methods: Retrospective study with radiological evaluation of patients diagnosed with subtalar arthrosis who underwent primary arthrodesis from January 2008 to December 2014. All patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers treated with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years were evaluated; whom 90 (40%) were smokers, and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was sequelae of calcaneal fractures. A bone graft was used in 27.7% patients. The overall union rate was 85.4%, and 14.6% of the patients developed pseudarthrosis. A significant difference was found in the nonunion rate of smokers versus nonsmokers (p=0.015), especially in those who did not receive a bone graft (p=0.014). However, no significant difference was found between smokers who received a bone graft and those who did not (p=0.072). The union rate was related to the donor site, with pseudarthrosis observed in 33.3% of surgeries involving a calcaneal autograft (p=0.011). Conclusion: Smoking increased the likelihood of pseudarthrosis in subtalar arthrodesis by 2.5 fold, and pseudarthrosis was related to the bone autograft donor site.
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