eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Triple Arthrodesis: Follow-up

Author: Stephen M Schroeder, DPM, Chief of Podiatric Foot and Ankle Surgery, Southwest Washington Medical Center
Coauthor(s): Enzo Sella, MD, Chief, Orthopedic Foot and Ankle Surgery, Yale-New Haven Hospital; Associate Clinical Professor, Department of Orthopedics and Rehabilitation, Yale University School of Medicine; Peter Blume, DPM, FACFAS, Assistant Clinical Professor of Surgery, Orthopaedics and Rehabilitation and Anesthesia, Yale School of Medicine, Yale New Haven Hospital; Director of North American Center for Limb Preservation; Raymond O'Hara, DPM, Chief Resident, Department of Orthopedic Surgery, Yale-New Haven Hospital
Contributor Information and Disclosures

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

 


More on Triple Arthrodesis

Overview: Triple Arthrodesis
Workup: Triple Arthrodesis
Treatment: Triple Arthrodesis
Follow-up: Triple Arthrodesis
Multimedia: Triple Arthrodesis
References

References

  1. Ryerson EW. Arthrodesing operations on the feet. J Bone Joint Surg. 1923;5:453-71.

  2. 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.

  3. Amis JA. Talus-Calcaneus-Cuboid (Triple) Arthrodesis. In: Johnson KA, ed. The Foot and Ankle. New York: Raven;. 1994: 369-400.

  4. 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].

  5. 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].

  6. 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].

  7. Bono JV, Jacobs RL. Triple arthrodesis through a single lateral approach: a cadaveric experiment. Foot Ankle. Sep 1992;13(7):408-12. [Medline].

  8. Duncan JW, Lovell WW. Hoke triple arthrodesis. J Bone Joint Surg Am. Sep 1978;60(6):795-8. [Medline].

  9. Fisher J. New ways to heal fractures enter market in the works. Orthop Today. 1996;16(1):24-6.

  10. 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].

  11. 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

Contributor Information and Disclosures

Author

Stephen M Schroeder, DPM, Chief of Podiatric Foot and Ankle Surgery, Southwest Washington Medical Center
Stephen M Schroeder, DPM is a member of the following medical societies: American College of Foot and Ankle Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Enzo Sella, MD, Chief, Orthopedic Foot and Ankle Surgery, Yale-New Haven Hospital; Associate Clinical Professor, Department of Orthopedics and Rehabilitation, Yale University School of Medicine
Enzo Sella, MD is a member of the following medical societies: Academy of Medical Royal Colleges, American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, and North American Spine Society
Disclosure: Nothing to disclose.

Peter Blume, DPM, FACFAS, Assistant Clinical Professor of Surgery, Orthopaedics and Rehabilitation and Anesthesia, Yale School of Medicine, Yale New Haven Hospital; Director of North American Center for Limb Preservation
Peter Blume, DPM, FACFAS is a member of the following medical societies: American College of Foot and Ankle Surgeons, American Diabetes Association, American Podiatric Medical Association, and International College of Angiology
Disclosure: Nothing to disclose.

Raymond O'Hara, DPM, Chief Resident, Department of Orthopedic Surgery, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

Medical Editor

Heidi M Stephens, MD, MBA, Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health
Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Florida Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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