Subtalar Arthrodesis: A Risk After Primary Tibiotalar Arthrodesis

Patients undergoing ankle fusion should first be counseled about the risk of subsequent subtalar arthrodesis, according to the results of a new study.

Patients at most risk for subtalar arthrodesis are those with diabetes, Charcot arthropathy, neuropathy, alcohol use, substance use disorder or psychiatric disease.

The study, “Short-term risk factors for subtalar arthrodesis after primary tibiotalar arthrodesis,” was published on April 9, 2022 in The Journal of Foot & Ankle Surgery.

“While adjacent joint arthritis is a recognized long-term downside of primary tibiotalar arthrodesis, few studies have identified risk factors for early subtalar arthrodesis after primary tibiotalar arthrodesis,” the researchers wrote.

All the patients included in the study were older than 18 years and had undergone primary tibiotalar arthrodesis between 2008 and 2016. The researchers analyzed demographic data as well data on comorbidities, prior operative procedures, post-operative procedures and subsequent subtalar arthrodesis.

They also obtained pre- and post-operative Kellgren-Lawrence osteoarthritis grade of the subtalar joint and postoperative radiographic alignment.

Overall, 20 of the 240 patients who were treated with primary tibiotalar arthrodesis had to also undergo subtalar arthrodesis within a median follow up of 13.8 months due to symptomatic nonunion in 13 (65%), progression of symptomatic subtalar osteoarthritis in 4 (20%), and symptomatic nonunion of primary tibiotalar arthrodesis combined progressively symptomatic subtalar osteoarthritis in 2 (10%).

“Preoperative radiographic subtalar osteoarthritis severity and postoperative radiographic alignment were not correlated with subsequent subtalar arthrodesis. Diabetes mellitus, Charcot arthropathy, neuropathy, alcohol use, substance use disorder and psychiatric disease were significantly associated with having a subsequent subtalar arthrodesis,” the researchers wrote.

“The most common postoperative contributing factor for subsequent subtalar arthrodesis following primary tibiotalar arthrodesis was the salvage of symptomatic ankle nonunion rather than subtalar joint disease.”

Study authors included Song Ho Chang, M.D., Ph.D., Noortje C. Hagemeijer, M.D., Ph.D., Jirawat Saengsin, M.D., Escar Kusema, M.D., Brandon L. Morris, M.D., Christopher W. DiGiovannia, M.D., FAOA, and Daniel Guss, M.D., M.B.A., all of Massachusetts General Hospital.