CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review

Abstract

Background: Ankle, hindfoot, and midfoot arthrodesis surgeries are standard procedures performed in orthopaedics to treat pain and functional disabilities. Although fusions can effectively improve pain and quality of life, nonunions remain a significant concern for surgeons. With the increased availability of computed tomography (CT), more surgeons rely on this modality for increased accuracy in determining whether a fusion was successful. The objective of this study was to report the rates of CT-confirmed fusion following ankle, hindfoot, or midfoot arthrodesis. Methods: A systematic review was performed using EMBASE, Medline, and Cochrane central register from January 2000 to March 2020. Inclusion criteria included studies with adults (<18 years) that received 1 or multiple fusions of the ankle, hindfoot, or midfoot. At least 75% of the study cohort must have been evaluated by CT postoperatively. Basic information was collected, including journal, author, year published, and level of evidence. Other specific information was collected, including patient risk factors, fusion site, surgical technique and fixation, adjuncts, union rates, criteria for successful fusion (%), and time of CT. Once data were collected, a descriptive and comparative analysis was performed. Results: Included studies (26, n = 1300) had an overall CT-confirmed fusion rate of 78.7% (69.6-87.7). Individual joints had an overall fusion rate of 83.0% (73-92.9). The highest rate of union was in the talonavicular joint (TNJ). Conclusion: These values are lower than previous studies, which found the same procedures to have greater than 90% fusion rates. With these updated figures, as confirmed by CT, surgeons will have better information for clinical decision making and when having informed consent conversations.

Response to “Letter Regarding: CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review”

“…We do continue to believe that the results that we present in our article are clinically relevant and can be used in practice as individual practitioners find appropriate for their patients. We also reiterate that we agree with the concerns regarding heterogeneity outlined by Berthold et al and this was communicated in our original article 1 : A major limitation of this study was the heterogeneity of surgical techniques and care pathways within the studies with usage of different bone grafts, approaches, and postoperative pathways. Additionally, most of the data are collected from level IV evidence sources and therefore may be subject to biases.…”

“…We want to thank Berthold et al for their comments in their letter to the editor regarding our recently published systematic review titled "CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review." 1 Our review aimed to understand better the fusion rate of ankle, hindfoot, and midfoot arthrodesis as determined by computed tomography (CT). As stated in our methods, our inclusion criteria were for studies with adult patients (>18 years old) who had undergone ankle, hindfoot, or midfoot fusions and had postoperative CT scans for at least 75% of their patient cohort.…”

Letter Regarding: CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review

“…Consequently, the authors ultimately compare subtalar arthrodesis for primary osteoarthritis to revision ankle/hindfoot-interposition-arthrodesis for a large bony defect after avascular necrosis (AVN)/total ankle arthroplasty (TAR), or high-risk patients to healthy individuals. 2 However, we believe that this heterogeneity prohibits any cumulative analysis of the data as conducted by the authors.…”

“…(TAR), or high-risk patients to healthy individuals. 2 However, we believe that this heterogeneity prohibits any cumulative analysis of the data as conducted by the authors.…”

“…We would like to congratulate Leslie et al 2 on their study titled “CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review.” The authors carried out a systematic review to evaluate the computed tomography (CT)–verified union rates in adult patients (<18 years) who had undergone ankle-, hind-, or midfoot fusion. Out of 4601 screened articles, 26 papers (n = 1300 patients) were included.…”