Risk of osteoarthritis secondary to partial or total arthrodesis of the subtalar and midtarsal joints after a minimum follow-up of 10 years - 10/04/14

Doi : 10.1016/j.otsr.2014.03.003

M. Ebalard ^a, G. Le Henaff ^b, G. Sigonney ^c, R. Lopes ^d, G. Kerhousse ^e, J. Brilhault ^f, D. Huten ^a,^⁎
^a Orthopaedic and Trauma Surgery Department, CHU Rennes, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
^b Orthopaedic and Trauma Surgery Department, CHU Brest, hôpital La-Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest, France
^c Orthopaedic and Trauma Surgery Department, CHU Rouen, hôpital Charles-Nicolle, pavillon Dève, 1, rue de Germont, 29000 Brest, France
^d Orthopaedic and Trauma Surgery Department, CHU Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes, France
^e CHP Saint-Grégoire, Orthopaedic Surgery Department, 36, boulevard de la Boutière, 35760 St-Grégoire, France
^f Orthopaedic and Trauma Surgery Department, CHU de Tours, hôpital Trousseau, 37044 Tours, cedex 09, France

^⁎Corresponding author. Tel.: +33 2 99 26 71 67.

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Abstract

Introduction

The goal of this retrospective, multicentre study was to evaluate the long-term outcomes in patients who have undergone partial or total arthrodesis of the subtalar and midtarsal joints.

Hypothesis

Secondary osteoarthritis of the adjacent joints can negatively affect the outcomes more than 10 years after these fusion procedures.

Material and Methods

The outcomes of 72 fusions (total: 22; partial: 50) performed between 1981 and 2002 were evaluated using the Maryland Foot Score (MFS), self-evaluation questionnaire and three weight-bearing X-ray views (Meary's with cerclage wire around heel, lateral and dorsoplantar). The average follow-up was 15±5 years (range 10–31).

Results

There were two deep infections that resolved after lavage and antibiotics therapy. There were 21 early complications (10 complex regional pain syndrome, 7 delayed wound healing, 2 superficial infections, 2 venous thrombosis) that all resolved. There were five cases of non-union (6.9%) that healed after being re-operated. After five years, secondary osteoarthritis led to the fusion being extended to the tibotalar joint (1 case) and midtarsal joint (1 case). At the last follow-up, the average MFS was 71.5 (range 25–100). Patient deemed the result as either excellent (10%), very good (9%), good (55%), poor (19%) or bad (7%). Pain at the last follow-up was present in 84% of cases. The rear-foot was normally aligned in 45% of cases, varus aligned in 22% and valgus aligned in 33%. The MFS was significantly better in patients with normal alignment. Patients with neurological foot disorders had significantly more preoperative (80% cavovarus) and postoperative foot deformity (P<0.05). At the last follow-up, the rate of secondary osteoarthritis in the surrounding joints was elevated: 73% tibiotalar, 58.3% subtalar, 65.8% talonavicular, 53.5% calaneocuboid. The presence of osteoarthritis was not correlated with pain or lower MFS. However there was significantly more pain at last follow-up than at 12 months postoperative and two fusions were required in patients with secondary osteoarthritis.

Conclusion

Although partial or total arthrodesis of the subtalar and midtarsal joints is a reliable procedure, it induces secondary osteoarthritis. Even though it seems to be well tolerated more than 10 years after the initial procedure, this possibility must be discussed with young, active patients.