Surgeons need to be aware of potential changes in height following tibiotalocalcaneal arthrodesis, researchers say.
Watch Out for Height Changes After Tibiotalocalcaneal Arthrodesis
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The study, “Change in Height Following Tibiotalocalcaneal Arthrodesis: Retrospective Radiographic Analysis,” was published online on November 20, 2022, in The Journal of Foot & Ankle Surgery.
Most research on tibiotalocalcaneal arthrodesis with an intramedullary rod focused on fixation techniques, deformity correction, and clinical outcomes, but there is little data on the potential height change that can happen after the procedure, the researchers said.
To better understand this, the research team retrospectively analyzed radiographs with novel radiographic techniques to determine the change in height from preoperative to postoperative radiographs following tibiotalocalcaneal arthrodesis.
The researchers divided the patients into three categories all of which were indications for surgical interventions:
- Charcot,
- arthritis, and
- pes planus.
Overall, the patients in the Charcot and arthritis groups had an average decrease in height on anterior and posterior measurements of the height from distal tibia to the calcaneous, while the pes planus had an increase in height.
The average change of height among the Charcot patients was -12.0 ±24.4 mm anteriorly and -7.6 ± 15.5 mm posteriorly, while it was -6.9 ± 6.7 mm anteriorly and -3.8 ± 5.8 posteriorly among the arthritis patients.
“Overall, we found a statistically significant difference in height change between the three groups in anterior measurements (p- value = 0.012) and posterior measurement (p- value = 0.006). We recommend surgeons who perform this procedure to be aware of the potential change in height to better tailor surgical and postoperative care,” the researchers wrote.
The study authors included Bryanna D. Vesely, DPM, MPH, Lindsay K. LeSavage, DPM, Matthew A. King, DPM, and Aaron T. Scott, M.D., all of the Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. Joni K. Evans, MS., of the Wake Forest School of Medicine in Winston-Salem, North Carolina also contributed to the study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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