Abstract
Purpose: Talonavicular arthritis, associated or not with rear foot deformity, is common in patients with rheumatoid arthritis. The work by Steinhauser and Gérard demonstrated the usefulness of talonavicular arthrodesis for the treatment of this rear foot disorder. The purpose of this study was to assess outcome after this surgical technique in patients with rheumatoid polyarthritis.
Material and methods: Between 1988 and 1998, 26 feet (24 men, 2 women, 17 right, 7 left) were operated by the same surgeon. Mean age of the patients at surgery was 51 years. Mean delay from disease onset to talonavicular arthrodesis was 13 years. Postoperative immobilisation lasted 45 days. Mean follow-up was five years (1–10).
Results: Patients were very satisfied or satisfied in 92.3% of the cases. Mean pre- and postoperative pain score was 8.14 and 1.77 respectively (p = 0.0001). Normal shoes could be worn by 37.5 and 66.7% of the patients pre- and postoperatively. Patient independence was significantly improved (p = 0.0001). The postoperative analysis of the plantar prints demonstrated pes planus and pes cavus. In 29.2 and 12.5%, the mean postoperative tibiocalcaneal angle was 0.78° with pes varus in eight cases (2°–10°). The mean Djean angle was 122.3° and 122.8° pre- and postoperatively (p = 0.24). Three talocrural joints (11.5%) that were intact preoperatively had degraded at last follow-up. The statistical analysis showed that clinical outcome was not affected by the postoperative aspect of the foot. There were three cases of tight non-union (11.5%) two of which were asymptomatic and two cases of infection (7.5%) requiring revision surgery. These complications led to two poor outcomes.
Discussion: The rate of non-union varies in published series from 3 to 37%. The rate observed in our series has led us to delay weight bearing. The residual varus found in eight feet, related to a shortened medial column, may warrant intertalonavicular grafting.
Conclusion: Talonavicular arthrodesis is a useful procedure despite a significant risk of complications.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
