Early results of a novel technique: Hindfoot fusion in talus osteonecrosis prior to ankle arthroplasty: A case series

• We aimed to study the clinical outcome of a 2 staged approach of Subtalar arthrodesis followed by TAR in patients with ankle arthritis and avascular necrosis of the talus.
• 7 patients out of 210 TARs performed at our institution underwent this 2 staged procedure between 2006 and 2010.
• There was significant improvement in clinical (AOFAS scores; p = 0.008) and patient reported outcomes (Womac pain and stiffness and SF-36 scores for 6/8 domains; p < 0.05).
• There was noted talar subsidence in 2 patients in the first year, which did not progress at 2 years and did not influence clinical outcome.
• We recommend this 2 staged approach in patients with ankle arthritis and AVN of talus to reduce ischaemic pain and improve the longevity of total ankle arthroplasty.

AbsractBackgroundThe purpose of this study was to evaluate the clinical outcome of a two staged approach of subtalar arthrodesis followed by TAR for patients with ankle arthritis and AVN talus.MethodsOut of total 210 TARs performed at our institute; 7 patients underwent a two staged procedure between 2006 and 2010. All patients had over 3 years of follow up (except one). The clinical results were assessed using AOFAS, WOMAC, SF-36 and patient satisfaction scores.ResultsThe mean follow up was 3 years. There was significant improvement in AOFAS and WOMAC (pain and stiffness) from pre-op to 3 years post-op (P < 0.05). SF 36 scores improved from pre-op to 3 years post-op for 6/8 domains. 5 patients were satisfied at 3 years for overall surgical outcomes, 4 were satisfied with pain relief. Radiological signs of talar subsidence were noted in 2 patients at year 1. This did not progress at 3 years and did not deteriorate clinical outcome.ConclusionWe recommend our two staged approach to deal with this difficult clinical problem. We believe this approach is safe for TAR surgery where talar vascularity and bone quality is questionable leading to reduced talar subsidence, ischaemic pain and improvement in longevity of TAR.Level of evidenceEvidence IV (Retrospective case series).