Iliac Periosteal Bone Autografting vs Talus Non-Weight-Bearing Surgery in Hepple V Talus Osteochondral Injuries: Comparative Analysis of Perioperative Outcomes.

Abstract

BACKGROUND Hepple stage V osteochondral injuries of the talus include subchondral cyst formation, secondary degenerative change, and secondary osteoarthritis. This retrospective study aimed to compare perioperative outcomes from iliac periosteal bone autografting and talus non-weight-bearing surgery in 162 patients with Hepple V osteochondral injuries of the talus. MATERIAL AND METHODS According to the inclusion criteria, 162 eligible patients were selected for analysis and divided into an iliac periosteal bone autograft group (n=82) and a talus non-weight-bearing group (n=80) according to the surgical methods. General data and data on perioperative conditions, complications, intraoperative fluoroscopy times, preoperative and postoperative visual analog scale (VAS) for pain, ankle-hindfoot scoring system (AOFAS Ankle-Hindfoot Scale), and plantar flexion and extension range of motion were collected to assess ankle joint function and were compared between groups. RESULTS The comparison of perioperative results between the 2 groups showed that the incision length (P=0.000), operation time (P=0.000), and length of hospital stay (P=0.000) in the iliac periosteal bone autograft group were longer than those in the talus non-weight-bearing group. The intraoperative blood loss in the anterior group was greater than that in non-weight-bearing group (P=0.000). Regarding complications, there were more cases of donor site paresthesia (P=0.014) and postoperative pain aggravation in the iliac periosteal bone autograft group than in the non-weight-bearing group. CONCLUSIONS In patients with Hepple V osteochondral injury of the talus, the incision length, operation time, and length of hospital stay in the talus non-weight-bearing group were shorter, there was less intraoperative blood loss, and there were fewer postoperative complications. In the short term, bone transplantation in the talus non-weight-bearing group was more "minimally invasive" and the postoperative recovery was better than in the iliac periosteal bone allograft group.