Bilateral excision arthroplasty and interpositional allograft for severe talonavicular osteoarthritis

摘要

Talonavicular joint osteoarthritis can be extremely painful and disabling. It is associated with pes planovalgus deformity, trauma, and inflammatory diseases such as rheumatoid arthritis. Conservative treatment options include oral analgesia, orthoses/custom shoes, and injections of steroid with local anesthetic. Operative treatments, such as fusion and replacement, have been described, with fusion being widely accepted as the gold standard. Isolated talonavicular joint fusion has been performed for congenital deformities, arthritic conditions (degenerative, inflammatory, posttraumatic), neuromuscular disease, and pes planovalgus deformities, with good results. Most surgeons undertake talonavicular fusion with the patient under a general or spinal anesthetic. Postoperatively, weight-bearing is usually restricted for approximately 3 months. This can lead to problems such as thrombosis and may be difficult for elderly patients with multiple medical comorbidities. It can also lead to failure of the procedure (screw breakage, nonunion) if the patient is unable to comply with the postoperative restrictions. Another factor to consider is peripheral vascular disease, which is more common in elderly patients. This, in conjunction with other medical comorbidities, such as chronic renal failure, can create a difficult milieu for osseous healing. This is an extraordinary challenge for allograft-host bone healing and consolidation in an area where fusion is difficult to achieve even under ideal circumstances. Therefore, appropriate patient selection, as with any operation, is important for the success of talonavicular fusion.