A CT-Validated Comparative Analysis of Fixation Constructs for Hindfoot Arthrodesis: Fusion and Complication Rates.

Abstract

Background: Hindfoot arthrodesis is a procedure commonly performed to address degenerative changes and/or malalignment of the hindfoot, yet robust literature comparing traditional and modern constructs is sparse. The purpose of this study is to evaluate the efficacy of nitinol staples in hindfoot arthrodesis as compared to isolated screws and combined staple and screw constructs.

Methods: A 10-year retrospective review of all patients undergoing hindfoot arthrodesis at our institution was performed. Hindfoot arthrodesis was defined as either a triple (subtalar, talonavicular, and calcaneocuboid), double (subtalar + talonavicular), or isolated arthrodesis. Outcomes included fusion success rate and reoperation rate. A postoperative CT confirming the presence or absence of osseous bridging was required for inclusion in the fusion outcome analysis.

Results: We assessed 113 patients who underwent arthrodesis procedures across 128 joints in the hindfoot. There was no significant difference in functional outcomes between screws, staples, or the combination screw and staple constructs used in hindfoot arthrodesis. However, screws alone were associated with a significantly higher complication rate than staple-only fixation (P = .028).

Conclusion: Nitinol staples are effective in hindfoot arthrodesis with respect to fusion success rate and may be associated with decreased revision rates compared with traditional screws only or staple plus screw constructs. Larger studies will be necessary to validate these findings and contribute to an assessment of the usage of these nascent constructs in hindfoot arthrodesis.

Level of evidence: Level III, retrospective cohort study.