eMedicine Specialties > Orthopedic Surgery > Foot & Ankle
Triple Arthrodesis: Follow-up
Updated: Feb 28, 2008
Outcome and Prognosis
Outcomes are typically good with high union rates of the subtalar and CC joints. The TN joint has the highest incidence of nonunion; however, this decreases with better understanding of the procedure and stable fixation. Degenerative changes at the unfused distal and proximal joints are still a long-term complication, but this is true with any fusion procedure. A study examining 400 triple arthrodesis procedures found less than perfect results in 24.5% of patients.
Up to 10 months are required for the patient to become pain free. Return to high-impact activity is not a given. Lower-impact activities like walking, cycling, and swimming should be obtainable goals postoperatively.
Future and Controversies
The future and controversy for this procedure pertain to using external fixation devices. Proponents would argue it to be a stable fixation method that allows the patients to ambulate with partial to full weight bearing on the operative side. Others would argue that the risk of pin-tract infections is high and could be disastrous to the procedure's outcome. A study looked at 87 patients using a ring-style external fixation device. A 97% fusion at 6-8 weeks, with 36% developing superficial pin-site infections, was reported.11
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References
Ryerson EW. Arthrodesing operations on the feet. J Bone Joint Surg. 1923;5:453-71.
Goecker RM, Ruch JA. Rearfoot arthrodesis. In: Banks AS, Downey MS, Martin DE, Miller SJ, eds. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. Vol 2. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 2001: 1167-92.
Amis JA. Talus-Calcaneus-Cuboid (Triple) Arthrodesis. In: Johnson KA, ed. The Foot and Ankle. New York: Raven;. 1994: 369-400.
Suckel A, Muller O, Herberts T, Langenstein P, Reize P, Wulker N. Talonavicular arthrodesis or triple arthrodesis: peak pressure in the adjacent joints measured in 8 cadaver specimens. Acta Orthop. Oct 2007;78(5):592-7. [Medline].
Jackson WF, Tryfonidis M, Cooke PH, Sharp RJ. Arthrodesis of the hindfoot for valgus deformity. An entirely medial approach. J Bone Joint Surg Br. Jul 2007;89(7):925-7. [Medline].
Maskill MP, Loveland JD, Mendicino RW, Saltrick K, Catanzariti AR. Triple arthrodesis for the adult-acquired flatfoot deformity. Clin Podiatr Med Surg. Oct 2007;24(4):765-78, x. [Medline].
Bono JV, Jacobs RL. Triple arthrodesis through a single lateral approach: a cadaveric experiment. Foot Ankle. Sep 1992;13(7):408-12. [Medline].
Duncan JW, Lovell WW. Hoke triple arthrodesis. J Bone Joint Surg Am. Sep 1978;60(6):795-8. [Medline].
Fisher J. New ways to heal fractures enter market in the works. Orthop Today. 1996;16(1):24-6.
Gellman H, Lenihan M, Halikis N, et al. Selective tarsal arthrodesis: an in vitro analysis of the effect on foot motion. Foot Ankle. Dec 1987;8(3):127-33. [Medline].
Talarico LM, Vito GR. Triple arthrodesis using external ring fixation and arched-wire compression: an evaluation of 87 patients. J Am Podiatr Med Assoc. Jan-Feb 2004;94(1):12-21. [Medline].
Further Reading
Keywords
joint fusion, talocalcaneal joint, talonavicular joint, calcaneocuboid joint, TC joint, TN joint, CC joint, foot arthrodesis, foot joints, degenerative joint disease, DJD, degenerative arthritis, arthritis, foot arthritis, varus deformity of the foot, valgus deformity of the foot
Follow-up: Triple Arthrodesis