Die Triple-Arthrodese in der Therapie degenerativer Rückfußfehlstellungen: Klinische, radiologische und pedobarografische Resultate

Abstract

Triple arthrodesis using internal fixation followed by sufficient immobilisation is a good and reliable technique for the correction of fixed hindfoot deformities. A very high level of patient satisfaction and a good clinical outcome can be achieved. Plantar pressure distribution can be reconstructed to a satisfactory extent. Due to the relatively high rate of degenerative arthritis in adjacent joints, the decision upon performing a triple arthrodesis should be considered carefully. Clinical and radiological integrity of these joints are required.

Clinical and Radiological Mid- to Long-term Results Following Triple Arthrodesis

“…The non-union rate of 11% in our study is similar to the data in the literature which range from 0% to 36% (2,4,(19)(20)(21)(22). Joveniaux et al reported complete bone healing in 28 subtalar fusions after an average duration of 13 weeks (25-75 percentile: 12-14) (21).…”

“…Overall satisfaction was described as excellent by 22 (85%), good by 2 (8%) patients and poor by no patient. (31) (4,20,32). De Groot et al only found 19 (53%) satisfied patients after TA, but 73% of his patients would agree to the operation again (18).…”

“…Missing hindfoot mobility after TA leads to a maximum of 44 instead of 50 points for function. Thus 94 points means the best result and 0 points the worst (4,11). Hannover score was used which contains 20 points for the best and 100 points for the worst outcome (12).…”

“…The first TA was introduced by Hoke in 1921, but the fundamental features of the contemporary operation trace back to Ryerson in 1923 (2,3). During the last century, the surgical technique underwent further modifications (2)(3)(4). TA is indicated for correction of several deformities and conditions of the hindfoot such as neuromuscular diseases, e.g.…”

“…Absolute contraindications include general surgical and anesthetic risks, acute or chronic infections, critical soft tissue conditions, severe peripheral arterial occlusive disease and destructive Charcot arthropathy (5). TA is also contraindicated in advanced arthrosis of adjacent joints, such as the ankle joint, the naviculo-cuneiform and the tarsometatarsal joints (4). Ultimately, the decision is up to the treating physician.…”