Clinical Experiences of Triple Arthrodesis

Chu, Chung Bin

Abstract

This is an analysis of 137 feet of triple arthrodesis over a period of 23 years.1964-1987. The average period of follow-up was 4 years and 2 months. The results are as follows. 1. The ratio of male to female was 64 to 68 cases, and right to left was 75 to 62 feet. 97 feet(70. 8%) were operated on between late 1960 and early 1970. 89 cases(67.4%) came for their initial examination when they were aged between 9-20 years. Age at the surgery was between 55/12-50 years, and among them 134 feet(97.8%) were operated after age of 8 years. 2. 128(93.4%) out of 132 cases were residual poliomyelitis, and 97(70.8%) out of 137 feet were equinovarus. 3. 100 out of 132 cases receiving triple arthrodesis also received a total of 179 additional procedures simultaneously to achieve better correction. The major additional procedure was. Achilles tendon lengthening in 81 cases followed by plantar fasciotomy in 49 cases. 4. Surgical approach was by Ollier's method, and arthrodesis by Lambrinudi's method. 5. 134 out of 137 feet required triple arthrodesis in order to correct the deformity. On this operative procedure it was utmost important to dissect the tarsal bones and surrounding soft tissues thoroughly to loosen and rearrange the joints. In this way even severe deformity was corrected satisfactorily. 6. At the time of Achilles tendon lengthening by Z-plasty deviding it longitudinally, on the tibial side the tendon was cut at the calcaneal attatchment, and on the fibular side at the proximal end. We think that this produced more efficient and satisfactory results especially in the correction of equinovarus. 7. Internal fixation was done by one staple on 110 feet and two staples on 7 feet. On one staple use, it was inserted connecting the talus and the cuboid. More firm contact between two bones as it progressing into bone was achieved by placing with slightly spread legged staple. 8. We could not find any pseudoarthrosis or delayed union. It is assumed the reason for this was good dissection of bone and joint, firm internal and external immobilization, and good postoperative management. 9. Talar and navicular necrosis occurred in 6 feet(4.4%), but did not affect the final fusion of the arthrodesis. In relatively severe necrosis, we found flattening of the talus and complaint of considerable pain but nevertheless, no special additional procedure was done. 10. We found some cases of postoperative degenerative hypertrophic osteoarthritis in tibio-talar and navicular-cuneiform joint. We feel this phenomenon is due to compensatory stress emanating from the fusion of three joint, and new contact of articular surfaces with changed biomechanical force. 11. When doing triple arthrodesis, the optimal age for surgery is 10-12 years, i.e., before the completion of bone growth, the reason is during the remaining period of bone growth, there is opportunity for the bone and other tissues to adjust to the newly formed stresses of weightbearing and joint motion. 12. Of a total of 137 feet receiving triple arthrodesis, excellent results were seen in 31(23%), good in 82(60%), fair 20(14%) and failed in 4(3%).