Arthroscopic triple and modified double hindfoot arthrodesis: technical note and case series

N.A. Jagodzinski, A.M.J. Parsons, S.W. Parsons

Introduction: In a consecutive series of 71 arthroscopic subtalar arthrodeses performed between 2004 and 2011, 14 also involved arthroscopic decortication of the talonavicular joint (double arthrodesis) and 4 the subtalar, talonavicular and calcaneocuboid joints (triple arthrodeses).

Methods: We examined complications, union rates in all 18 patients and clinical outcomes in 16 for whom this was the sole procedure.

Results: Mean age was 62 (45 - 78). Two talonavicular joints failed to unite and a third patient suffered a diabetic Charcot midfoot neuro-arthropathy. These patients’ outcomes were classified as poor. Two patients underwent planned major ankle or midfoot surgery in addition to arthroscopic double arthrodeses. These joints united but these patients were not included in the clinical review to avoid confounding outcomes. Mean follow-up for the remaining 13 patients was 4.4 (1.75 - 7.5) years. There were no immediate perioperative complications. All 4 patients with triple fusions united with good or excellent outcomes. The nine patients receiving double arthrodesis united with 8 good or excellent outcomes. The remaining patient reported good deformity correction and stability but disappointing pain relief, (classification poor).

Conclusions: Double and triple arthrodeses remain valid salvage options for painful arthrosis and severe deformity. Preservation of the calcaneocuboid joint permits a relative lateral column lengthening when correcting planovalgus deformity. Arthroscopic surgery offers preservation and protection of soft tissues and reduces wound tension. The sinus tarsi approach permits good visualisation and decortication of the triple joints and rotatory correction of deformity. This technique is not appropriate when there is extensive bone loss requiring block bone grafting. Early complications are reduced and late complications such as non-union and arthrosis of adjacent joints seem similar to those reported in studies on open arthrodeses.