Is an unresected subtalar joint a cause of failure in tibiotalocalcaneal arthrodesis with a nail?

Year 2024, Volume: 8 Issue: 2, 99 - 104, 30.08.2024

Melih Ünal , Hasan May , Ali Bozdemir , Muhammed Ergün , Ferhat Güler

https://doi.org/10.30565/medalanya.1437224

Abstract

Aim: In this study, we aimed to evaluate clinical and functional outcomes of tibiotalocalcaneal arthrodesis (TTCA) using intramedullary nailing (IMN) without cartilage resection of the subtalar (ST) joint.

Methods: 22 ankles of 21 patients (one patient was bilateral), who underwent TTCA using IMN without cartilage resection of the ST joint in our clinic between January 2013 and December 2022 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, etiology, Kellgren-Lawrence classification, postoperative fusion rate, fusion status and complications were recorded. The European Quality of Life 5 Dimensions (EQ-5D) scores were also noted.

Results: Ten patients were male and 11 were female. The mean age was 54.7±14.9 years. The mean follow-up was 46.4±19.1 months. The mean best health status score of the EQ-5D (EQ-VAS) was 73.9±16.5. Tibiotalar (TT) fusion occurred in all patients, while ST fusion was not achieved in ten patients. Four of these patients underwent secondary procedures, while no intervention was planned for the other six patients because they were asymptomatic.

Conclusions: This study has demonstrated that unresected subtalar articular cartilage leads to a significant rate of ST fusion failure. Nevertheless, the possibility of partial fusion or fibrous fusion at the reaming site is thought to be the reason for the high rate of asymptomatic patients.

Keywords

Tibiotalocalcaneal, arthrodesis, intramedullary nailing, osteoarthritis, subtalar joint resection

Çivi ile tibiotalokalkaneal artrodezde subtalar eklemin rezeke edilmemiş olması başarısızlık nedeni midir?

Abstract

Amaç: Bu çalışmanın amacı, subtalar (ST) eklemde kıkırdak rezeksiyonu yapılmadan intramedüller çivileme (İMÇ) ile tibiotalokalkaneal artrodezin (TTKA) klinik ve fonksiyonel sonuçlarını değerlendirmektir.

Yöntemler: Ocak 2013- Aralık 2022 tarihleri arasında kliniğimizde ST eklemin kıkırdak rezeksiyonu yapılmaksızın İMÇ ile TTKA gerçekleştirilen 21 hastanın 22 ayak bileği (bir hasta bilateral) retrospektif olarak incelendi. Hastaların demografik ve klinik özellikleri, etiyolojileri, Kellgren-Lawrence sınıflandırması, ameliyat sonrası kaynama oranı, füzyon durumu ve komplikasyonları kaydedildi. Avrupa Yaşam Kalitesi 5 Boyut (EQ-5D) skorları da not edildi.

Bulgular: Hastaların 10’u erkek, 11’i kadın olup, ortalama yaşı 54.7±14.9 yıl idi. Ortalama takip süresi 46.4±19.1 ay idi. EQ-5D’de en iyi sağlık skoru ortalaması 73.9±16.5 idi. Hastaların tümünde tibiotalar (TT) füzyon görülürken, on hastada ST füzyon elde edilemedi. Bu hastaların dördünde sekonder prosedürler uygulanırken, diğer altı hastada asemptomatik olması sebebiyle girişim planlanmadı.

Sonuç: Bu çalışma subtalar eklem kıkırdağının rezeke edilmemesinin ciddi oranda ST füzyon başarısızlığına neden olduğunu göstermiştir. Buna rağmen, hastaların yüksek oranda asemptomatik olmalarının nedeni olarak, oyma bölgesindeki kısmi füzyon ya da fibröz füzyon olasılığı düşünülmektedir.

Keywords

Tibiotalokalkaneal, artrodez, intramedüller çivileme, osteoartrit, subtalar eklem rezeksiyonu

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