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Abstract

Background:

Osteonecrosis of the talus is a well-recognized pathology, which can result in significant hindfoot collapse resulting in poor function and pain. Treatment with intramedullary tibiotalocalcaneal arthrodesis (IMTCA) using a retrograde intramedullary nail is widely utilized for severe concomitant tibiotalar and subtalar pathologies. This study reports the results of ankle and hindfoot arthrodesis in patients with arthritis and deformity caused specifically by talar osteonecrosis.

Methods:

Fourteen ankle and hindfoot arthrodeses with retrograde intramedullary nail were studied, with a mean follow-up of 26 months. Medical records were reviewed for operative technique, concomitant procedures, bone graft used, and postoperative complications including nonunion, infection, nerve injury, wound healing issues, and the need for additional surgeries. Clinical outcomes included Visual Analogue Scale for pain, the AOFAS Ankle/Hindfoot Score, and the SF-36 questionnaire.

Results:

Over 80% of cases had osteonecrosis involving the entire body of the talus. In 4 cases tibiocalcaneal arthrodesis was performed, with the remaining talar head-neck portion fused to anterior aspect of tibia. Union was achieved in all cases. The mean preoperative VAS score was 6.9 (range 5 to 9, SD ± 1.5) decreasing to 1.7 (range 0 to 6, SD ± 2.2) postoperatively (P = .00008). The mean preoperative AOFAS score was 32.7 (range 20 to 46, SD ± 8.7), increasing to 72.1 (range 46 to 86, SD ± 10.1, P = .00003). The mean preoperative SF-36 physical component score was 30.5 (range 21 to 42, SD ± 6.9) increasing to 42.8 (range 20 to 60, SD ± 11.4) postoperatively (P = .02). Complications included 1 stress fracture, 4 hardware removals, and 1 superficial infection.

Conclusion:

Ankle and hindfoot arthrosis due to extensive talar AVN can be successfully treated with IMTCA.

Level of Evidence:

Level IV, retrospective case series.

Keywords

tibiotalocalcaneal tibiocalcaneal arthrodesis fusion hindfoot retrograde intramedullary nail talus avascular necrosis osteonecrosis

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References

Adelaar

Madrian

. Avascular necrosis of the talus. Orthop Clin North Am. 2004;35:383-395, xi.

Anderson

Linder

Rydholm

. Tibio-talocalcaneal arthrodesis as a primary procedure using a retrograde intramedullary nail: a retrospective study of 26 patients with rheumatoid arthritis. Acta Orthop. 2005;76:580-587.

Blair

. Comminuted fractures and fracture dislocations of the body of the astragalus: operative treatment. Am J Surg. 1943;59:37-43.

Brodsky

Verschae

Tenenbaum

. Surgical correction of severe deformity of the ankle and hindfoot by arthrodesis using a compressing retrograde intramedullary nail. Foot Ankle Int. 2014;35(4):360-367.

Canale

Kelly

Jr . Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978;60:143-156.

Caravaggi

Cimmino

Caruso

Dalla Noce

. Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot. J Foot Ankle Surg. 2006;45:20-24.

Chiodo

Herbst

. Osteonecrosis of the talus. Foot Ankle Clin. 2004;9:745-755, vi.

Chou

Mann

Yaszay

. Tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2000;21(10):804-808.

Dalla Paola

Volpe

Varotto

. Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure. Foot Ankle Int. 2007;28(9):967-970.

10.

Delanois

Mont

Yoon

Mizell

Hungerford

. Atraumatic osteonecrosis of the talus. J Bone Joint Surg Am. 1998;80:529-536.

11.

Dennis

Tullos

. Blair tibiotalar arthrodesis for injuries to the talus. J Bone Joint Surg Am. 1980;62:103-107.

12.

Dennison

Pool

Simonis

Singh

. Tibiocalcaneal fusion for avascular necrosis of the talus. J Bone Joint Surg Br. 2001;83:199-203.

13.

DeVries

Berlet

Hyer

. Union rate of tibiotalocalcaneal nails with internal or external bone stimulation. Foot Ankle Int. 2012;33(11):969-978.

14.

DeVries

Philbin

Hyer

. Retrograde intramedullary nail arthrodesis for avascular necrosis of the talus. Foot Ankle Int. 2010;31(11):965-972.

15.

DiGiovanni

Patel

Calfee

Nickisch

. Osteonecrosis in the foot. J Am Acad Orthop Surg. 2007;15:208-217.

16.

Fujimori

Yoshino

Koiwa

. Ankle arthrodesis in rheumatoid arthritis using an intramedullary nail with fins. Foot Ankle Int. 1999;20(8):485-490.

17.

Hammett

Hepple

Forster

Winson

. Tibiotalocalcaneal (hindfoot) arthrodesis by retrograde intramedullary nailing using a curved locking nail. The results of 52 procedures. Foot Ankle Int. 2005;26(10):810-815.

18.

Hawkins

. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52:991-1002.

19.

Henderson

. Posttraumatic necrosis of the talus: the Hawkins sign versus magnetic resonance imaging. J Orthop Trauma. 1991;5:96-99.

20.

Horst

Gilbert

Nunley

. Avascular necrosis of the talus: current treatment options. Foot Ankle Clin. 2004;9:757-773.

21.

Hussl

Sailer

Daniaux

Pechlaner

. Revascularization of a partially necrotic talus with a vascularized bone graft from the iliac crest. Arch Orthop Trauma Surg. 1989;108:27-29.

22.

Jehan

Shakeel

Bing

Hill

. The success of tibiotalocalcaneal arthrodesis with intramedullary nailing—a systematic review of the literature. Acta Orthop Belg. 2011;77:644-651.

23.

Jeng

Campbell

Tang

Cerrato

Myerson

. Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 2013;34(9):1256-1266.

24.

Johl

Kircher

Pohlmannn

Jansson

. Management of failed total ankle replacement with a retrograde short femoral nail: a case report. J Orthop Trauma. 2006;20:60-65.

25.

Kemnitz

Moens

Peerlinck

Fabry

. Avascular necrosis of the talus in children with haemophilia. J Pediatr Orthop B. 2002;11:73-78.

26.

Kile

Donnelly

Gehrke

Werner

Johnson

. Tibiotalocalcaneal arthrodesis with an intramedullary device. Foot Ankle Int. 1994;15(12):669-673.

27.

Kitaoka

Patzer

. Arthrodesis for the treatment of arthrosis of the ankle and osteonecrosis of the talus. J Bone Joint Surg Am. 1998;80:370-379.

28.

Kotnis

Pasapula

Anwar

Cooke

Sharp

. The management of failed ankle replacement. J Bone Joint Surg Br. 2006;88:1039-1047.

29.

Leduc

Clare

Laflamme

Walling

. Posttraumatic avascular necrosis of the talus. Foot Ankle Clin. 2008;13:753-765.

30.

Lemon

Somayaji

Khaleel

Elliott

. Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail. J Bone Joint Surg Br. 2005;87:809-813.

31.

Mader

Verheyen

Gausepohl

Pennig

. Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion. Strategies Trauma Limb Reconstr. 2007;2:39-47.

32.

Mont

Schon

Hungerford

. Avascular necrosis of the talus treated by core decompression. J Bone Joint Surg Br. 1996;78:827-830.

33.

Moore

Prince

Pochatko

Smith

Fleming

. Retrograde intramedullary nailing for ankle arthrodesis. Foot Ankle Int. 1995;16(7):433-436.

34.

Nagashima

Tachihara

Matsuzaki

. Follow-up study of ankle arthrodesis in severe hind foot deformity in patients with rheumatoid arthritis using an intramedullary nail with fins. Mod Rheumatol. 2005;15:269-274.

35.

Ochman

Evers

Raschke

Vordemvenne

. Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss. J Foot Ankle Surg. 2012;51:675-679.

36.

Pelton

Hofer

Thordarson

. Tibiotalocalcaneal arthrodesis using a dynamically locked retrograde intramedullary nail. Foot Ankle Int. 2006;27(10):759-763.

37.

Penny

Davis

. Fractures and fracture-dislocations of the neck of the talus. J Trauma. 1980;20:1029-1037.

38.

Pinzur

Noonan

. Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. Foot Ankle Int. 2005;26(7):545-549.

39.

Rammelt

Pyrc

Agren

. Tibiotalocalcaneal fusion using the hindfoot arthrodesis nail: a multicenter study. Foot Ankle Int. 2013;34(9):1245-1255.

40.

Thomas

Sathe

Habib

. The use of intramedullary nails in tibiotalocalcaneal arthrodesis. J Am Acad Orthop Surg. 2012;20:1-7.

41.

Thomason

Eyres

. A technique of fusion for failed total replacement of the ankle: tibio-allograft-calcaneal fusion with a locked retrograde intramedullary nail. J Bone Joint Surg Br. 2008;90:885-888.

42.

Urquhart

Mont

Michelson

Krackow

Hungerford

. Osteonecrosis of the talus: treatment by hindfoot fusion. Foot Ankle Int. 1996;17(5):275-282.

43.

Vallier

Reichard

Boyd

Moore

. A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am. 2014;96:192-197.

44.

Van Bergeyk

Stotler

Beals

Manoli

II . Functional outcome after modified Blair tibiotalar arthrodesis for talar osteonecrosis. Foot Ankle Int. 2003;24(10):765-770.

Salvage of Avascular Necrosis of the Talus by Combined Ankle and Hindfoot Arthrodesis Without Structural Bone Graft

Abstract

Background:

Methods:

Results:

Conclusion:

Level of Evidence:

Keywords

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References