Isolated Subtalar Arthrodesis for Avascular Necrosis of the Talus

Transcription

1 Isolated Subtalar Arthrodesis for Avascular Necrosis of the Talus Travis J. Dekker, MD Manuel J. Pelligrini, MD Adam P. Schiff, MD James K. DeOrio, MD Mark E. Easley, MD James A. Nunley, MD Samuel B. Adams, MD

2 Disclosure - No conflicts to disclose Isolated Subtalar Arthrodesis for Avascular Necrosis of the Talus Travis J. Dekker, MD Manuel J. Pelligrini, MD Adam P. Schiff, MD James K. DeOrio, MD Mark E. Easley, MD James A. Nunley, MD Samuel B. Adams, MD Our disclosures are in the final AOFAS Mobile App. We have no potential conflicts with this presentation.

3 - Avascular necrosis (AVN) of the talus can lead to subtalar arthritis, pain, and decreased function. - Primary subtalar arthrodesis in the setting of AVN is thought to restore a degree of vascularity due to calcaneal bone ingrowth. - Hypothesis: Primary successful fusion rates will be lower in patients with traumatic etiology for talar AVN and thus will have increased rates of secondary procedures.

4 Methods - 12 patients identified - 6 patients traumatic etiology - 6 patients atraumatic etiology - Surgical Technique - Lateral approach: 7 cases - Posterior approach: 3 cases - Medial approach: 2 cases *** Biologic adjuvant added in all cases - Follow up: - Minimum: time point of fusion - Maximum: 8.4 years - Average: 3.8 years (7mo- 8.4 years)

5 Results: - Fusion occurred in 12/12 patients - 3/3 radiographic fusion with no clinical symptoms - 9/9 fused by CT using Glazebrook et. al. s criteria with overall fusion mass of 73% - Secondary procedures - Traumatic: 5/6 major secondary procedures - Atraumatic: 1/6 major secondary procedures

6 Case 1 Example: Traumatic - 33 yo female - Traumatic subtalar dislocation with secondary AVN - Surgery: Subtalar fusion with two 7.5mm cannulated screws along with BMP, allograft bone chips and DBX. Final result: Near complete fusion mass on both CT and radiographs with complete resolution of pain and no secondary procedures.

7 Case 2 Example: Traumatic - 35 yo female - Traumatic AVN secondary to prior talar neck fracture - Surgery: Subtalar fusion performed with two 7.5mm cannulated screws, a single 5.5mm screw and along with BMP, allograft bone chips and DBX. Final result: A subsequent CT demonstrated medial talus collapse (C & D). The patient was revised to a TTC arthrodesis (E & F).

8 Discussion: - Study confirms Devalia et. al. findings of 100% fusion rate in setting of talar AVN - High incidence of secondary procedure in patients with traumatic etiology - Atraumatic etiology has increased rate of both radiographic and clinical success

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