INTRODUCTION: Primary triple arthrodesis is a powerful and reliable procedure for stabilizing and correcting painful rigid flatfoot deformities with a low rate of complications. STEP 1 PREOPERATIVE PLANNING: Pay careful attention to the history, physical examination, and weight-bearing radiographic studies as they are critical for selecting patients who will benefit from a triple arthrodesis. STEP 2 ROOM SETUP AND PATIENT POSITIONING: Position the patient supine on the operating table with the toes pointing straight up to the ceiling. STEP 3 INCISIONS AND EXPOSURE: For a standard triple arthrodesis, use 2 incisions: a lateral sinus tarsi incision, which allows exposure of the subtalar joint, CC joint, and lateral aspect of the TN joint, and a medial incision, which provides exposure of the TN joint. STEP 4 JOINT PREPARATION: Ensure that joint preparation is thorough as this is critical for the success of any hindfoot arthrodesis. STEP 5 REDUCTION OF DEFORMITY: Reduce the TN joint first, followed by the subtalar joint, restoring a plantigrade foot and approximately 5° of hindfoot valgus alignment. STEP 6 JOINT FIXATION: Perform rigid fixation of the subtalar joint first, followed by fixation of the TN and CC joints. STEP 7 ACCESSORY PROCEDURES: Accessory procedures are often required in addition to the triple arthrodesis to ensure that appropriate hindfoot alignment and a plantigrade foot are achieved. STEP 8 WOUND CLOSURE: Perform a staged wound closure, taking care to maximize soft-tissue coverage over the involved hindfoot joints. STEP 9 POSTOPERATIVE CARE: Ensure that the patient follows strict non-weight-bearing precautions in the immediate postoperative period to limit micromotion at the arthrodesis sites and allow for timely fusion. RESULTS: In one of the largest published series of patients managed with triple arthrodesis (111 patients), Pell et al. reported a union rate of 98% at a minimum follow-up of 2 years, with 91% of patients indicating that they would be willing to repeat the procedure under similar circumstances4.
INTRODUCTION: Primary triple arthrodesis is a powerful and reliable procedure for stabilizing and correcting painful rigid flatfoot deformities with a low rate of complications. STEP 1 PREOPERATIVE PLANNING: Pay careful attention to the history, physical examination, and weight-bearing radiographic studies as they are critical for selecting patients who will benefit from a triple arthrodesis. STEP 2 ROOM SETUP AND PATIENT POSITIONING: Position the patient supine on the operating table with the toes pointing straight up to the ceiling. STEP 3 INCISIONS AND EXPOSURE: For a standard triple arthrodesis, use 2 incisions: a lateral sinus tarsi incision, which allows exposure of the subtalar joint, CC joint, and lateral aspect of the TN joint, and a medial incision, which provides exposure of the TN joint. STEP 4 JOINT PREPARATION: Ensure that joint preparation is thorough as this is critical for the success of any hindfoot arthrodesis. STEP 5 REDUCTION OF DEFORMITY: Reduce the TN joint first, followed by the subtalar joint, restoring a plantigrade foot and approximately 5° of hindfoot valgus alignment. STEP 6 JOINT FIXATION: Perform rigid fixation of the subtalar joint first, followed by fixation of the TN and CC joints. STEP 7 ACCESSORY PROCEDURES: Accessory procedures are often required in addition to the triple arthrodesis to ensure that appropriate hindfoot alignment and a plantigrade foot are achieved. STEP 8 WOUND CLOSURE: Perform a staged wound closure, taking care to maximize soft-tissue coverage over the involved hindfoot joints. STEP 9 POSTOPERATIVE CARE: Ensure that the patient follows strict non-weight-bearing precautions in the immediate postoperative period to limit micromotion at the arthrodesis sites and allow for timely fusion. RESULTS: In one of the largest published series of patients managed with triple arthrodesis (111 patients), Pell et al. reported a union rate of 98% at a minimum follow-up of 2 years, with 91% of patients indicating that they would be willing to repeat the procedure under similar circumstances4.
Authors: Amr A Fadle; Wael El-Adly; Ahmed Khalil Attia; Mo'men M Mohamed; Aly Mohamadean; Ahmed E Osman Journal: Int Orthop Date: 2021-04-25 Impact factor: 3.075