Triple Arthrodesis in Adults With Non-Paralytic Disease

Smith, Ronald W.; Shen, Wen; Dewitt, Sarah E.; Reischl, Stephen F.

doi:10.2106/00004623-200412000-00018

Cited by 63 publications

(30 citation statements)

References 20 publications

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“…Additive fusions of the talonavicular and calcaneocuboid joints, resulting in double [29] and triple arthrodeses [28,31], respectively, are done when arthritic joint changes, deformity and symptoms clearly extend to the midtarsal joints (Chopart's).…”

Section: Introductionmentioning

confidence: 99%

How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model

Hutchinson

Baxter

Gilbert

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background While successful subtalar joint arthrodesis provides pain relief, resultant alterations in ankle biomechanics need to be considered, as this procedure may predispose the remaining hindfoot and tibiotalar joint to accelerated degenerative changes. However, the biomechanical consequences of isolated subtalar joint arthrodesis and additive fusions of the Chopart's joints on tibiotalar joint biomechanics remain poorly understood. Questions/purposes We asked: What is the effect of isolated subtalar fusion and sequential Chopart's joint fusions of the talonavicular and calcaneocuboid joints on tibiotalar joint (1) mechanics and (2) kinematics during loading for neutral, inverted, and everted orientations of the foot? Methods We evaluated the total force, contact area, and the magnitude and distribution of the contact stress on the articular surface of the talar dome, while simultaneously tracking the position of the talus relative to the tibia during loading in seven fresh-frozen cadaver feet. Each foot was loaded in the unfused, intact control condition followed by three randomized simulated hindfoot arthrodesis modalities: subtalar, double (subtalar and talonavicular), and triple (subtalar, talonavicular, and calcaneocuboid) arthrodesis. The intact and arthrodesis conditions were tested in three alignments using a metallic wedge insert: neutral (flat), 10°i nverted, and 10°everted. Results Tibiotalar mechanics (total force and contact area) and kinematics (external rotation) differed owing to hindfoot arthrodeses. After subtalar arthrodesis, there were Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® decreases in total force (445 ± 142 N, 95% CI, 340-550 N, versus 588 ± 118 N, 95% CI, 500-676 N; p \ 0.001) and contact area (282 mm 2 , 95% CI, 222-342 mm 2 , versus 336 ± 96 mm 2 , 95% CI, 265-407 mm 2 ; p \ 0.026) detected during loading in the neutral position; these changes also were seen in the everted foot position. Hindfoot arthrodesis also was associated with increased external rotation of the tibiotalar joint during loading: subtalar arthrodesis in the neutral loading position (3.3°± 1.6°; 95% CI, 2°-4.6°; p = 0.004) and everted loading position (4.8°± 2.6°; 95% CI, 2.7°-6.8°; p = 0.043); double arthrodesis in neutral (4.4°± 2°; 95% CI, 2.8°-6°; p = 0.003) and inverted positions (5.8°± 2.6°; 95% CI, 3.7°-7.9°; p = 0.002), and triple arthrodesis in all loaded orientations including neutral (4.5°±1.8°; 95% CI, 3.1°-5.9°; p = 0.002), inverted (6.4°± 3.5°; 95% CI, 3.6°-9.2°; p = 0.009), and everted (3.6°± 2°; 95% CI, 2°-5.2°; p = 0.053) positions. Finally, after subtalar arthrodesis, additive fusions at Chopart's joints did not appear to result in additional observe...

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Section: Introductionmentioning

confidence: 99%

How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model

Hutchinson

Baxter

Gilbert

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Smith et al (2004) observed severe clinically abnormal changes in the ankle joint in 7 of 26 feet after 14 years. In that study, further cases of joint degenera- tion in 7 naviculocuneiform joints and in 6 tarsometatarsal joints were described.…”

Section: Discussionmentioning

confidence: 90%

Talonavicular arthrodesis or triple arthrodesis: Peak pressure in the adjacent joints measured in 8 cadaver specimens

Suckel¹,

Müller²,

Herberts³

et al. 2007

Acta Orthopaedica

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Background Talonavicular arthrodesis is a differential indication for triple arthrodesis. Differences regarding intraarticular pressure loads on the adjacent joints have not been investigated to date, but they are of clinical relevance when considering long-term joint degeneration.Methods We used a dynamic foot model to measure intraarticular peak pressures with electronic sensors in 8 anatomical specimens in different areas of the ankle joint and in the naviculocuneiform joint. Force was applied to extrinsic tendons via cables attached to computer-regulated hydraulic cylinders. A ground reaction force was simulated in a tilting angle-and force-controlled translation stage. Results We measured significantly higher peak pressures in the ankle joint after triple arthrodesis (5.7 Mpa) than after talonavicular arthrodesis (5.2 Mpa), with differences especially in the anterior section (5.2 Mpa as compared to 4.6 Mpa). Centrally, the peak pressure was similar, at 4.6 MPa and 4.5 Mpa, respectively. In the posterior area, the peak pressure after triple arthrodesis was lower (4.1 MPa as opposed to 4.4 Mpa). After triple arthrodeses, we measured higher values laterally/medially in the ankle joint (5.5 MPa/4.6 Mpa) than after talonavicular arthrodesis (5.1 MPa/4.4 Mpa). In the naviculocuneiform joint, we again saw higher peak pressures after triple arthrodesis than after talonavicular arthrodesis.Interpretation Our findings from this cadaver study indicate a lower and more evenly distributed peak pressure load in the ankle joint after talonavicular

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“…Reconstructive surgery aims at the restoration of normal alignment that will be accompanied by fusion of the affected joint(s) in the vast majority of cases. Corrective fusion at the talonavicular and calcaneocuboid joint, as well as double and triple fusion in the hindfoot, leads to partial functional rehabilitation and the considerable reduction of pain [8,9,15,18]. However, normal range of motion will not Figures 3a to 3h.…”

Section: Discussionmentioning

confidence: 99%

“…The results from clinical series with posttraumatic deformities will have to be awaited. It appears from the available data that triple arthrodesis has a better longterm prognosis after the correction of posttraumatic deformities than in patients with rheumatoid and degenerative joint disease [18].…”

Section: Discussionmentioning

confidence: 99%

Anatomic Reconstruction of Malunited Chopart Joint Injuries

et al. 2010

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Fractures and dislocations at the mid-tarsal (Chopart) joint are frequently overlooked or misinterpreted at first presentation. Inadequate joint reduction and stabilization almost invariably lead to painful malunions or nonunions, residual instability, and deformity. Because of the central position and the essential function of the mid-tarsal joint, malunions lead to a considerable impairment of global foot function and the rapid development of posttraumatic arthritis. While secondary anatomical reconstruction with joint preservation would be desirable in order to restore normal foot function, it is amenable only if no symptomatic arthritis or avascular necrosis is present. Over a course of 6 years, eight patients have been treated with secondary correction, joint realignment, and internal fixation. In four of these cases, nonunions of the tarsal navicular were debrided and bone-grafted; in the remaining cases, a corrective osteotomy at the navicular or cuboid was carried out. At 2 years followup, all but one patient were satisfied with the result. One patient underwent fusion of the talonavicular joint for avascular necrosis and collapse of the navicular. The mean American Orthopaedic Foot and Ankle Score (AOFAS) improved significantly from 38.8 preoperatively to 80.8 at follow-up. However, the majority of malunited mid-tarsal fracture-dislocations will require corrective fusion of the affected joint(s) with axial realignment because of manifest posttraumatic arthritis at the time of patient presentation.

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Triple Arthrodesis in Adults With Non-Paralytic Disease

Cited by 63 publications

References 20 publications

How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model

How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model

Talonavicular arthrodesis or triple arthrodesis: Peak pressure in the adjacent joints measured in 8 cadaver specimens

Anatomic Reconstruction of Malunited Chopart Joint Injuries

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