Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Surgeon, Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan.
Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
J Foot Ankle Surg. 2020 Mar-Apr;59(2):440-444. doi: 10.1053/j.jfas.2019.08.029.
Talonavicular joint arthritis is a great concern after ankle fusion. Although arthrodesis is the gold standard treatment for this complication, it could initiate a vicious cycle of further adjacent joint arthritis. An alternative that may delay or eliminate the need for arthrodesis is excision arthroplasty; however, there are only a few reports on its application on a talonavicular joint. We report 3 cases of excision arthroplasty with interpositional Achilles tendon autograft for the treatment of end-stage talonavicular osteoarthritis in low-demand elderly patients. In 1 patient, excision arthroplasty was performed after tibiotalocalcaneal arthrodesis, and in 2 patients, it was performed after tibiotalar arthrodesis, in which the subtalar joints were also damaged and fused simultaneously on performance of the interpositional arthroplasty of the talonavicular joint. In all cases, pain relief and functional activities of daily living improvement were achieved with this procedure. At a minimum follow-up of 1 year, no patient reported adjacent joint symptoms or flatfoot progression. These cases show that interpositional arthroplasty with Achilles tendon autograft is an effective treatment for end-stage talonavicular arthritis in patients with fused ankle and subtalar joints. This procedure was helpful in relieving pain and improving activities of daily living function in low-demand elderly patients with the preservation of movement of the talonavicular joint. Autograft was considered to be superior to other grafts with respect to availability, graft rejection, or allergy development. Fused subtalar joint resolved the concerning issues, such as flatfoot progression and muscular weakness of ankle plantar flexion, associated with this procedure.
距跟关节关节炎是踝关节融合后的一大关注点。虽然融合术是治疗这种并发症的金标准，但它可能会引发进一步相邻关节关节炎的恶性循环。一种可能延迟或消除融合术需求的替代方法是关节切除成形术；然而，关于其在距跟关节应用的报道仅有少数。我们报告了 3 例采用跟腱自体移植物置入的距跟关节切除成形术治疗低需求老年患者终末期距跟骨关节炎的病例。1 例在距下关节融合术后行关节切除成形术，2 例在距下关节融合术后行关节切除成形术，其中在施行距跟关节置入性关节成形术时，同时也损伤和融合了跗骨间关节。所有病例均通过该手术达到了缓解疼痛和改善日常生活活动功能的效果。在至少 1 年的随访中，没有患者报告出现相邻关节症状或平足进展。这些病例表明，跟腱自体移植物置入性关节切除成形术是融合的踝关节和距下关节患者终末期距跟关节炎的有效治疗方法。对于运动需求较低的老年患者，该手术有助于缓解疼痛和改善日常生活活动功能，同时保留距跟关节的运动。自体移植物在可用性、移植物排斥或过敏发展方面被认为优于其他移植物。融合的距下关节解决了与该手术相关的问题，如平足进展和踝关节跖屈的肌肉无力。
