For posttraumatic conditions, hemiarthroplasty led to better results within four weeks and seemed to be a suitable alternative to other procedures, especially in older patients. Patients with primary osteoarthritis and idiopathic humeral head necrosis can expect good to excellent results after hemiarthroplasty. In both groups, the overall results depend mainly upon patient compliance and the state of the rotator cuff.
This is a prospective clinical and radiological study of the treatment of talocalcaneal deformity or degeneration by a modified technique of isolated talocalcaneal fusion. Thirty-six patients were evaluated with clinical examination, plain dorsoplantar and oblique radiographs, and computed tomography scanning or magnetic resonance imaging in a follow-up of 32.5 months (range, 20-62 months). Indications for arthrodesis were posterior tibial tendon rupture with secondary osteoarthritis (12 cases) and secondary posttraumatic osteoarthritis (24 cases). On a visual analog pain scale, the patients graded their pain at 4.4 before surgery and at 1.1 after surgery. The subjective results were 33% complete satisfaction, 28% satisfaction with minor reservation, 31% satisfaction with major reservation, and 9% dissatisfaction. The overall objective results were excellent in 47%, good in 31%, fair in 17%, and poor in 6% of cases. A further advantage of this type of talocalcaneal fusion is a large remaining range of motion in the neighboring joints, at the ankle (in 76% the same or better ROM than before surgery), and at Chopart's joint (in 69% the same or better ROM than before surgery). The fusion rate was high (95%).
Triple arthrodesis respects the functional unit of the subtalar joint, but shows several intraoperative difficulties such as surfaces of resection that are too large or wrong positions between the hind and the middle foot. Furthermore postoperative problems like walking on uneven pavements, a reduced range of motion in the adjacent joints and the development of osteoarthritis of the ankle are not easy to deal with. Therefore isolated fusions of the talocalcaneal, talonavicular and calcaneo-cuboidal joint with a minimal resection technique seem to present several advantages. Among them we would mention a minimal reduction of the range of motion, the preservation of a physiological position of the adjacent joints and the prevention of osteoarthritis in the adjacent joint which rarely appears and when it does only in an asymptomatic form. The subtalar implants and the astragaloplasty as possibilities to treat disorders of the subtalar joint complex are also discussed.
Juvenile bunions have different etiologies and require specific operative approaches. Any operative procedure to correct a juvenile hallux valgus deformity should correct all the components of the deformity, i.e. pronation of the hallux, the increased hallux valgus angle, the enlarged medial eminence, the increased intermetatarsal angle, and hypermobility or obliquity of the first metatarso-cuneiform joint with the intention of decreasing the rate of recurrence.
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