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

Yıl 2024, Cilt: 8 Sayı: 2, 99 - 104, 30.08.2024

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

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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Lexer E. Die Verwedung der freien Knochenplastik nebst Versuchen über Gelenkversteifung und Gelenktransplanten. Langenbecks Archive für Klin. Chirung. 1906;86:938. 2. Adams JC. Arthrodesis of the ankle joint; experiences with the transfibular approach. J Bone Joint Surg Br. 1948;30B(3):506-11. PMID: 18877986.
• 3. Dalla Paola L, Volpe A, Varotto D, Postorino A, Brocco E, Senesi A et al. Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure. Foot Ankle Int. 2007;28(9):967-70. doi: 10.3113/FAI.2007.0967.
• 4. Fujimori J, Yoshino S, Koiwa M, Nakamura H, Shiga H, Nagashima S. Ankle arthrodesis in rheumatoid arthritis using an intramedullary nail with fins. Foot Ankle Int. 1999;20(8):485-90. doi: 10.1177/107110079902000804.
• 5. Tan YY, Nambiar M, Onggo JR, Hickey BA, Babazadeh S, Tay WH et al. Tibio-Talar-Calcaneal Nail Fixation for Ankle Fractures: A Systematic Review and Meta-Analysis. J Foot Ankle Surg. 2022;61(6):1325-1333. doi: 10.1053/j.jfas.2021.10.006.
• 6. Gavaskar AS, Chowdary N. Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail for advanced tuberculous arthritis of the ankle. J Orthop Surg (Hong Kong). 2009;17(3):321-4. doi: 10.1177/230949900901700316.
• 7. Mendicino RW, Catanzariti AR, Saltrick KR, Dombek MF, Tullis BL, Statler TK et al. Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing. J Foot Ankle Surg. 2004;43(2):82-6. doi: 10.1053/j.jfas.2004.01.012.
• 8. Burns PR, Dunse A. Tibiotalocalcaneal Arthrodesis for Foot and Ankle Deformities. Clin Podiatr Med Surg. 2017;34(3):357-380. doi: 10.1016/j.cpm.2017.02.007.
• 9. Mulhern JL, Protzman NM, Levene MJ, Martin SM, Fleming JJ, Clements JR, Brigido SA. Is Subtalar Joint Cartilage Resection Necessary for Tibiotalocalcaneal Arthrodesis via Intramedullary Nail? A Multicenter Evaluation. J Foot Ankle Surg. 2016;55(3):572-7. doi: 10.1053/j.jfas.2015.11.007.
• 10. Stone KH, Helal B. A method of ankle stabilization. Clin Orthop Relat Res. 1991;(268):102-6.
• 11. Franceschi F, Franceschetti E, Torre G, Papalia R, Samuelsson K, Karlsson J et al. Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1316-25. doi: 10.1007/s00167-015-3548-1.
• 12. Moore TJ, Prince R, Pochatko D, Smith JW, Fleming S. Retrograde intramedullary nailing for ankle arthrodesis. Foot Ankle Int. 1995;16(7):433-6. doi: 10.1177/107110079501600710.
• 13. Gross JB, Belleville R, Nespola A, Poircuitte JM, Coudane H, Mainard D et al. Influencing factors of functional result and bone union in tibiotalocalcaneal arthrodesis with intramedullary locking nail: a retrospective series of 30 cases. Eur J Orthop Surg Traumatol. 2014;24(4):627-33. doi: 10.1007/s00590-013-1347-2.
• 14. Asomugha EU, Den Hartog BD, Junko JT, Alexander IJ. Tibiotalocalcaneal Fusion for Severe Deformity and Bone Loss. J Am Acad Orthop Surg. 2016 Mar;24(3):125-34. doi: 10.5435/JAAOS-D-14-00102.
• 15. Fleming SS, Moore TJ, Hutton WC. Biomechanical analysis of hindfoot fixation using an intramedullary rod. J South Orthop Assoc. 1998 Spring;7(1):19-26. PMID: 9570728.
• 16. Brodsky JW, Verschae G, Tenenbaum S. Surgical correction of severe deformity of the ankle and hindfoot by arthrodesis using a compressing retrograde intramedullary nail. Foot Ankle Int. 2014;35(4):360-7. doi: 10.1177/1071100714523270.
• 17. Goebel M, Gerdesmeyer L, Mückley T, Schmitt-Sody M, Diehl P, Stienstra et al.. Retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis: a short-term, prospective study. J Foot Ankle Surg. 2006;45(2):98-106. doi: 10.1053/j.jfas.2005.12.001.
• 18. Jehan S, Shakeel M, Bing AJ, Hill SO. The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature. Acta Orthop Belg. 2011 Oct;77(5):644-51. PMID: 22187841.
• 19. Hammett R, Hepple S, Forster B, Winson I. Tibiotalocalcaneal (hindfoot) arthrodesis by retrograde intramedullary nailing using a curved locking nail. The results of 52 procedures. Foot Ankle Int. 2005;26(10):810-5. doi: 10.1177/107110070502601004.
• 20. Lauge-Pedersen H. Percutaneous arthrodesis. Acta Orthop Scand Suppl. 2003;74(307):I, 1-30. doi: 10.1080/03008820310014109.
• 21. Ferreira GF, Pedroso JP, Nunes GA, Del Vecchio JJ, Lewis TL, Mattos E Dinato MC, Nogueira VB, Filho MVP. Treatment of hallux rigidus with percutaneous metatarsophalangeal arthrodesis: a case series with a minimum follow-up of 2 years. Arch Orthop Trauma Surg. 2023;143(11):6521-6526. doi: 10.1007/s00402-023-04948-1.
• 22. Hodel S, Viehöfer A, Wirth S. Minimally invasive arthrodesis of the first metatarsophalangeal joint: A systematic literature review. Foot Ankle Surg. 2020;26(6):601-606. doi: 10.1016/j.fas.2019.09.001.
• 23. Boer R, Mader K, Pennig D, Verheyen CC. Tibiotalocalcaneal arthrodesis using a reamed retrograde locking nail. Clin Orthop Relat Res. 2007 Oct;463:151-6. PMID: 17960678