SLR - June 2016 - Ashleigh E. Wells
Reference: Rungprai C, Phisitkul P, Femino J, Martin K, Saltzman C, Amendola A. Outcomes and Complications After Open Versus Posterior Arthroscopic Subtalar Arthrodesis in 121 Patients. J Bone Joint Surg Am. 2016 Apr 20; 98(8):636–646.Scientific Literature Review
Reviewed By: Ashleigh E. Wells, DPM
Residency Program: Wake Forest Baptist Health
Podiatric Relevance: Subtalar arthritis is a painful condition that is frequently related to trauma as well as primary arthritis, tarsal coalitions and inflammatory joint disease. Over the years, open subtalar arthrodesis has demonstrated to be effective in relieving pain and improving function in patients continuing to suffer from subtalar arthritis after conservative treatment has failed. However, with the advancement of arthroscopic techniques, many surgeons have begun incorporating the use of arthroscopic assistance into traditionally open procedures, including subtalar arthrodesis. In this study, the authors sought to determine the functional and clinical outcomes as well as the complications in open versus arthroscopic subtalar arthrodesis.
Methods: The authors performed a retrospective chart review of 121 consecutive patients (129 feet) who underwent subtalar arthrodesis by open (60 feet in 57 patients) or arthroscopic (69 feet in 54 patients) technique between 2001 and 2014 by one of four fellowship-trained foot and ankle surgeons. Surgical technique was chosen based on the patient’s deformity and the surgeon’s preference. Primary measures included function outcomes based on the visual analog scale (VAS), Short Form (SF)-36, Foot Function Index (FFI) and Angus and Cowell rating scores as well as clinical outcomes, such as length of hospital stay, hindfoot alignment, fusion rate and time to recover based on ability to return to work, daily activity and sports. Complications were included as a secondary outcome measure.
Results: There was significant improvement in VAS, SF-36, FFI and Angus and Cowell rating scale scores for both groups. No difference was seen between operative time, VAS score, Angus and Cowell rating score or hindfoot alignment. The union rate and time to union with respect to screw size or types of bone graft did not differ among techniques. Overall, 47 of 129 feet had complications with no predilection seen for either group. However, hardware-related symptoms were more often seen with the arthroscopic technique while the open technique demonstrated a higher rate of sural nerve injuries.
Conclusion: Subtalar arthritis can have a large impact on patients' lives due to pain with activity. Both open and arthroscopic subtalar arthrodesis demonstrated significant improvement in patient outcomes in terms of pain and function suggesting that both techniques can increase quality of life. Overall, no technique showed superiority with respect to union rates. However, arthroscopically assisted arthrodesis showed a significantly shorter time to fusion as well as return to work, daily living activities and sports, which could be important factors to consider when planning surgical technique, especially in the young and/or active patient.