Fusion of the subtalar joint is an accepted method for numerous hindfoot pathologies. Various open techniques have been reported with similar good to excellent results. We designed this prospective analysis to evaluate the efficacy of arthroscopic subtalar fusion to compare the outcome with standard open techniques.

Method: 51 adults with a mean age of 42 years (range 21–75) were operated due to persistant pain and impaired function of the hindfoot unresponsive to symptomatic treatment. Patients were excluded if a significant deformity was present. Scoring was done according to the AOFAS ankle-hindfoot scale preoperatively and at each follow-up exam. A summery of the surgical technique is further given.

Results: 53 arthroscopic subtalar fusions were performed in 51 patients. At final follow-up (minimum 2 years) the AOFAS score improved from 52 preoperatively to 88 points. Non-unions were not observed. Clinical outcome was good and excellent in over 95% of all cases. Progression of degeneration in adjacent joints was minimal. Through the arthroscopic approach intraoperative visualization and preparation of the fusion site is superior to the open technique. Furthermore the clinical outcome supports the use of the endoscopic technique for the treatment of painful osteoarthritis of the hindfoot.

Routine ultrasound evaluation of neonates and young infants for congenital dislocation of the hip has been recommended. We have used the methods of decision analysis to determine whether every neonate should be examined by ultrasound or just those at increased risk. We have also studied the reliability and accuracy of ultrasound in following infants during observation and treatment, using published data. We find that ultrasound is not the preferred strategy for the screening of neonates, and that its role in evaluating high-risk patients depends on the point of view. For an individual, when third parties are bearing the cost, ultrasound is useful. For society as a whole, the routine ultrasound evaluation of the high-risk patient is not advantageous. For follow-up, ultrasound using the methods of Graf has a low reliability and there are no adequate data for methods using dynamic assessment.