Midterm outcomes of midfoot and hindfoot arthrodesis with strut allograft for Müller–Weiss disease

Abstract

Background Müller–Weiss disease (MWD), a rare dysplastic disorder of the foot, is characterized by deformity, sclerosis, and fragmentation of the lateral part of navicular bone. Arthrodesis is the mainstay treatment for MWD. Generally, arthrodesis can be achieved through internal fixation with metallic implants, and morselized chip bone may be packed into the gap for better bone union. However, with this procedure, the original foot size is not maintained and support for the foot arch is not provided. Sequela of short foot, or flatfoot is commonly observed even though these complications of surgery had not been reported with cases of MWD treated by arthrodesis. Herein, we present a retrospective analysis of treating MWD through midfoot and hindfoot arthrodesis combined with strut allograft. Methods From August 2006 to June 2019, 20 patients with MWD (mean age, 59.6 years; range, 40–80 years) underwent midfoot and hindfoot arthrodesis with strut bone allograft and were followed for at least 24 months. The patients were able to ambulate and participate in rehabilitation programs 3 months postoperatively. Results The used four radiographic parameters (Meary’s angle in anteroposterior and lateral view, talonavicular coverage angle, calcaneal pitch) demonstrated significant differences (P < .05) preoperatively and postoperatively, but those between the postoperative values and the values at the last follow-up session did not, indicating that strut allograft was able to maintain normal alignment. The mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scores at 2 years postoperatively revealed significant improvement from baseline, from 60.2 to 84.2 (P < .05). The 12-item Short Form Health Survey scores also improved significantly (P < .05). All patients reported substantial pain relief and exhibited improved functional outcomes and gait patterns. Conclusions For advanced-stage MWD, arthrodesis with a precisely shaped, size-matched strut allograft provided strong support for biomechanical alignment and enhanced functional performance.

Müller-Weiss Disease: Midfoot Arthrodesis in Reduction vs Malreduction

“…Moreover, regression analysis revealed a positive correlation between midfoot abduction and postoperative pain after midfoot arthrodesis ( P = .007). These results are consistent with those of Harnroongroj et al 14 When reviewing previous MWD literature and scrutinizing their illustrations, we found that most researchers focused more on restoring the medial longitudinal arch, 4,10,17,19 medial column length, 10,31 hindfoot alignment, 5,18,24 and perinavicular arthrodesis through malreduction, 3,11,13,20 while overlooking midfoot abduction. The clinical AOFAS and VAS scores in the reduction group were better than those in the malreduction group (all P < .05), implying that the pain was caused not only by the degeneration of the involved joints, but also by impaired biomechanics, such as the midfoot abduction deformity represented by the TMT1dp, leading to an uneven load distribution on the foot (Figures 1, 5, and 6).…”

“…Given that pathological changes in MWD mainly affect the peri-navicular joints, Fernández et al 10 proposed TNC arthrodesis in the early stage and achieved excellent consolidation results. Furthermore, surgeons have developed multiple improved surgical approaches based on midfoot arthrodesis, [2][3][4]11,13,17,20,31,32 and performed selective arthrodesis according to the range of arthritis involvement, including triple arthrodesis, TN arthrodesis, and calcaneal-cuboid arthrodesis. 19,21 Midfoot arthrodesis remains the first-line surgical intervention for treating MWD.…”

“…Nonetheless, most researchers concur that MWD should be conservatively managed for the first 2-6 months, followed by surgical intervention for patients whose symptoms have not improved. 2,4,10,14,17,20,21,32 Additionally, the application of various surgical options focusing on peri-navicular arthrodesis has been described in a few case reports. [2][3][4]10,11,13,17,20,31,32 These surgical approaches share two common goals: (1) pain reduction via fusion of symptomatic degenerative joints and (2) restoration of the plantar vault and medial longitudinal arches via correction of the lateral Meary's line.…”

“…2,4,10,14,17,20,21,32 Additionally, the application of various surgical options focusing on peri-navicular arthrodesis has been described in a few case reports. [2][3][4]10,11,13,17,20,31,32 These surgical approaches share two common goals: (1) pain reduction via fusion of symptomatic degenerative joints and (2) restoration of the plantar vault and medial longitudinal arches via correction of the lateral Meary's line. 4,10,23,25,26,28 The American Orthopaedic Foot & Ankle Society (AOFAS) functional assessment score has been shown to vary between 82 and 90.9 in peri-navicular arthrodesis, [2][3][4]11,13,17,20,31,32 with the majority of midfoot arthrodesis studies reporting favorable outcomes.…”

“…Indeed, we followed up on many surgical patients with MWD in our outpatient clinic, but our results may not be as optimistic as previously reported findings. [2][3][4]11,13,17,20,31,32 With a limited number of midfoot arthrodesis cases, researchers seem to have focused more on reduction in the sagittal plane or in situ arthrodesis while overlooking reduction in the horizontal plane. Harnroongroj et al 14 identified midfoot abduction as one of the main factors influencing conservative treatment failure in MWD.…”