Die talokalkaneare Interpositionsarthrodese

Abstract

Objective: Interposition arthrodesis for reliable treatment of instabilities, malalignments, and pain in the talocalcaneal joint. Excision of articular cartilage and interposition of autogenous cancellous bone maintaining the physiologic height of the hindfoot. Indications: Painful osteoarthritis and instability of the talocalcaneal joint, frequently with concomitant malalignment of the hindfoot, after unsuccessful conservative treatment including orthotics. Contraindications: Osteoarthritis of adjacent joints. Surgical Technique: Inframalleolar lateral approach. The short extensor muscle toes is retracted distally. The sinus tarsi is freed from fatty tissue and ligaments. Excision of cartilage and sclerotic subchondral bone from the talocalcaneal joint. A notch is cut into the sinus tarsi and filled with cancellous bone from the iliac crest. Talocalcaneal fixation in the required joint position using a cannulated cancellous lag screw. Postoperative immobilization in a plastic boot, no weight bearing for 6 weeks. Partial weight bearing for the next 6 weeks with continued immobilization in a splint. 3 months postoperatively, timely bony consolidation provided, full weight bearing is allowed and musculoskeletal rehabilitation commenced. Results: In a prospective study, 30 patients were clinically and radiologically (dorsoplantar, lateral and oblique views as well as computed tomography and/or magnetic res onance imaging) evaluated 34.4 (10-68) months postoperatively. Indications for the fusion were ruptures of the tibialis posterior tendon with secondary osteoarthritis in eight patients, and osteotraumatic osteoarthritis of the talocalcaneal joint in 22. Patients expressed pain on a visual analog scale as having been 4.4 prior to and 0.9 points after the operation. Subjectively, 17 were completely satisfied, nine were satisfied with few and four with some reservations. No patient was dissatisfied. Objective results were excellent in 25, good in three, and satisfactory in two patients. Primary fusion rate amounted to 95%. © Urban & Vogel München 2004.