Failure of triple arthrodesis.

In the longest-term follow-up study on triple arthrodesis published to date, Saltzman et al found at 44 years post-fusion, 95% of surviving patients were satisfied with their outcomes despite deteriorating function and some increase in pain with time [13]. All of the cases in this review were performed through a single anterolateral surgical approach and without internal fixation. In symptomatic severe or arthritic pes planovalgus or cavovarus deformity, few operative alternatives to triple arthrodesis are available. Attempts at subtalar resurfacing prostheses led to poor results and subsequent abandonment [46,47], whereas tendon transfer procedures and osteotomy realignments are not always possible or feasible in every patient. Although the indications for and surgical techniques used in triple arthrodesis have evolved and improved with time (predictably improving results in the intermediate term), triple arthrodesis remains a salvage procedure. Thus, deteriorating results with time may be an expected consequence and should not necessarily represent a failure of the technique. The surgical procedure is technically challenging and should be reserved for those surgeons trained and comfortable with all aspects of the surgery. Patient selection is vital, with most triple arthrodeses reserved for older patients. The two-incision approach allows better visualization, particularly of the talonavicular articulation, allowing for adequate resection of cartilage and alignment of the joints. Avoidance of excessive bony resection or wedge resection and the use of rigid internal fixation has increased the reliability of the procedure and diminished the pseudarthrosis rate and the rate of recurrence of the deformity. Failure to perform the procedure in an optimal fashion, however, can lead to a devastating failure with severe pain and dysfunction for the patient.