Operative Orthopadie und Traumatologie · 2026
[Minimally invasive arthrodesis of the talonavicular joint].
Аннотация на английскомСтатьяОбзорНазвание и аннотация: Перевод в очереди
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Shukla D, Beschauner J, Felsberg M, Rump C, Arbab D, Zeh A, Delank K-St, Gutteck N, Werneburg F
Аннотация
OBJECTIVE: The primary objective of minimally invasive talonavicular arthrodesis is to achieve realignment and biomechanical stabilization of the hindfoot through targeted fusion of the talonavicular joint.
INDICATIONS: This procedure is indicated in cases of idiopathic or posttraumatic talonavicular joint arthritis, with or without associated malalignment. It may also serve as part of a multilevel hindfoot reconstruction.
CONTRAINDICATIONS: Contraindications include general medical inoperability and local infection at the surgical site. Relative contraindications may include severe peripheral vascular insufficiency or systemic conditions impairing wound or bone healing.
SURGICAL TECHNIQUE: Talonavicular fusion is performed via a minimally invasive, percutaneous approach using cannulated compression screws.
POSTOPERATIVE MANAGEMENT: Postoperative care consisted of 6 weeks of mobilization in a below-knee walker with foot contact but without active loading. After radiological assessment at 6 weeks, a gradual transition to full weight-bearing in a stable shoe with a rigid sole was initiated. Physical therapy supported the restoration of mobility and gait function. Thromboprophylaxis was maintained until full mobilization.
RESULTS: In this retrospective analysis, 31 patients (32 feet) met the inclusion criteria and were evaluated. Of these, 18 underwent isolated talonavicular arthrodesis, 6 received an additional calcaneal osteotomy, and 8 underwent combined talonavicular and subtalar arthrodesis. The mean clinical follow-up was 131 days (± 89.9). Marked functional improvement was observed across the cohort. The mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score increased from 54.5 ± 17.4 preoperatively to 90.3 ± 9.6 at final follow-up, a change that was statistically significant (p < 0.0001) and associated with a very large effect size (Cohen's d = 2.71). Stratified analysis revealed that patients with lower baseline scores demonstrated greater relative improvement, while those with higher initial scores still achieved excellent absolute outcomes. Radiographic assessment demonstrated a marked postoperative correction of the tarsometatarsal angle, with the mean dorsoplantar angle improving from -4.6° (± 11.8) to -0.03° (± 1.5; p = 0.072), and the lateral angle from -3.8° (± 11.8) to -0.4° (± 2.4; p = 0.113). Although both changes narrowly missed statistical significance, they reflect a consistent and clinically relevant restoration of medial column alignment. Importantly, no postoperative complications-such as pseudarthrosis, wound healing disturbances, implant-related symptoms, or neurovascular impairment-were observed during the follow-up period, underscoring the procedural safety and reproducibility of the technique.
LEVEL OF EVIDENCE: IV (Retrospective case series).
INDICATIONS: This procedure is indicated in cases of idiopathic or posttraumatic talonavicular joint arthritis, with or without associated malalignment. It may also serve as part of a multilevel hindfoot reconstruction.
CONTRAINDICATIONS: Contraindications include general medical inoperability and local infection at the surgical site. Relative contraindications may include severe peripheral vascular insufficiency or systemic conditions impairing wound or bone healing.
SURGICAL TECHNIQUE: Talonavicular fusion is performed via a minimally invasive, percutaneous approach using cannulated compression screws.
POSTOPERATIVE MANAGEMENT: Postoperative care consisted of 6 weeks of mobilization in a below-knee walker with foot contact but without active loading. After radiological assessment at 6 weeks, a gradual transition to full weight-bearing in a stable shoe with a rigid sole was initiated. Physical therapy supported the restoration of mobility and gait function. Thromboprophylaxis was maintained until full mobilization.
RESULTS: In this retrospective analysis, 31 patients (32 feet) met the inclusion criteria and were evaluated. Of these, 18 underwent isolated talonavicular arthrodesis, 6 received an additional calcaneal osteotomy, and 8 underwent combined talonavicular and subtalar arthrodesis. The mean clinical follow-up was 131 days (± 89.9). Marked functional improvement was observed across the cohort. The mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score increased from 54.5 ± 17.4 preoperatively to 90.3 ± 9.6 at final follow-up, a change that was statistically significant (p < 0.0001) and associated with a very large effect size (Cohen's d = 2.71). Stratified analysis revealed that patients with lower baseline scores demonstrated greater relative improvement, while those with higher initial scores still achieved excellent absolute outcomes. Radiographic assessment demonstrated a marked postoperative correction of the tarsometatarsal angle, with the mean dorsoplantar angle improving from -4.6° (± 11.8) to -0.03° (± 1.5; p = 0.072), and the lateral angle from -3.8° (± 11.8) to -0.4° (± 2.4; p = 0.113). Although both changes narrowly missed statistical significance, they reflect a consistent and clinically relevant restoration of medial column alignment. Importantly, no postoperative complications-such as pseudarthrosis, wound healing disturbances, implant-related symptoms, or neurovascular impairment-were observed during the follow-up period, underscoring the procedural safety and reproducibility of the technique.
LEVEL OF EVIDENCE: IV (Retrospective case series).