Union Rates Following Power Rasp Joint Preparation for Foot and Ankle Arthrodesis: A Retrospective Study of 418 Fusions.

Abstract

Joint arthrodesis is a very common surgical approach in foot and ankle surgery at various anatomic levels. Several techniques have demonstrated the ability to provide successful fusion with appropriate preparation of the joint in question. With that in mind, the joint preparation, regardless of approach or instrumentation, is consistently the most time-consuming. Additionally, this step is prone to eventual complications like shortening with saw cuts or inadequate preparation with curettes and osteotomes alone, not to mention the persistent threat of non-union as is the case with any osteotomy or arthrodesis. Power rasp instrumentation presents a potential alternative for the surgeon to not only improve operating room efficiency, but also provide fast, reproducible, and adequate joint preparation thereby yielding excellent union rates. This study retrospectively analyzed 418 total arthrodesis attempts performed on 198 patients. Procedures included Lapidus bunionectomy/1st tarsometatarsal joint (TMTJ) fusion, midfoot fusions involving more than one TMTJ, isolated subtalar joint fusions (STJ), isolated talonavicular fusions (TNJ), and triple arthrodesis (STJ, TNJ, CCJ). The procedures were performed at a single institution with power rasp joint preparation (PJRP) as the primary tool for debridement of all cartilage from the articular surfaces of the joint in question. Minimum follow-up was 12 months. Radiographic union was defined on X-rays with osseous bridging and trabeculation across the fusion site using standard weightbearing foot radiographs taken at 3-, 6-, and 12-month intervals postoperatively. Four- and one-half percent of all arthrodesis attempts went on to develop a radiographic non-union after 12 months (19/418). This study demonstrates excellent overall union rates using a simple device that provides ease of surgeon use, minimal risk of non-union, and time-cost efficiency for providers, patients, and facilities alike.