Systematic Review of Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis

Abstract

Background: Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many controversies still exist regarding SDA. The objective of this study was to present an overview of outcomes following SDA, focusing on surgical technique as well as clinical and radiographic results. Methods: MEDLINE and EMBASE were queried and data abstraction was performed by 2 independent reviewers. Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels I to IV, (3) with at least 5 patients, and (4) reporting clinical and/or radiographic outcomes of SDA. Results: Twenty-five studies matched the inclusion criteria (2 Level III and 23 Level IV studies) including 492 feet in 467 patients. The most common indication for SDA was late complications of calcaneus fractures. Many different operative techniques have been described, and there is no proven superiority of one method over the other. The most commonly reported complications were nonunion, hardware prominence, wound complications, and sural neuralgia. All studies showed both radiographic and clinical improvement at the last follow-up visit compared with the preoperative evaluation. Pooled results (12 studies, 237 patients) demonstrated improved American Orthopaedic Foot & Ankle Society ankle-hindfoot scores with a weighted average of 33 points of improvement. Conclusion: SDA provides good clinical results at short-term and midterm follow-up, with improvement in ankle function as well as acceptable complication and failure rates. Higher quality studies are necessary to better assess outcomes between different operative techniques. Level of Evidence: Level III.

Midterm Outcome of Subtalar Joint Revision Arthrodesis

“…7,29,36 This complication is especially encountered in case of distraction and interposition of bone graft due to tension of the nerve. 17,36 In our series, 1 patient (5%) reported dysesthesia along the lateral side of the foot. Revision and nerve dissection were required because of pain persistence despite conservative measures.…”

“…4 In this study, no allograft was used, as several reports have shown that autograft is superior in union rates compared with allograft. 15 Nevertheless, a systematic review of subtalar distraction arthrodesis performed by Fletcher et al 17 stated that recent studies have observed identical union rates using allograft. The choice of the adequate osteosynthesis implant and the optimal positioning are also leading factors in the operation success.…”

“…The lateral curved incision seems to be more prone to dehiscence and more difficult to close distally, especially in case of bone graft, compared with the dorsal approach. 8,17,18,32,36 However, this incision offers better visualization and easier access to the anterior calcaneal facet. We encountered 2 infections (10%) that were restricted to the superficial wound area.…”

“…The nonunion rate for open 15 or arthroscopic 19 subtalar joint arthrodesis ranges between 0% and 24% in the literature 5,12,13,15,17,19,[25][26][27]40 regardless of which operative strategy is used for this purpose. 13 Sound arthrodesis is typically judged on clinical and radiographic bases.…”

“…13 A lower union rate has been observed in patients with multiple morbidities such as trauma, smoking, diabetes, infection, Charcot neuroarthropathy, obesity, an older age, deficient bone stock, or failed fusion. 9,17,38,40 Preexisting ankle fusion is associated with a higher failure rate of adjacent subtalar arthrodesis. 15,39 Although failure of subtalar arthrodesis has been frequently reported, treatment options are not yet sufficiently emphasized.…”