Selective Arthrodesis for Treatment of Symptomatic Müller-Weiss Disease

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Müller-Weiss Disease (MWD) is also known as Müller-Weiss Syndrome, which is reported an uncommon adult navicular osteonecrosis, frequently occurring in middle-aged and old females and characterized by compression and fragmentation of the lateral aspect of the navicular bone and progressive malformation. In this study, we report the results of selective midfoot and hindfoot arthrodesis for treating symptomatic MWD. Methods: From January 2006 to December 2011, 28 patients (31 feet) with MWD were treated with selective arthrodesis with tricortical autologous iliac crest block fixated by screws and plate and retrospectively reviewed. These included 24 females and 4 males, with an average age of 53.1 years (31-65 years), and an average symptoms duration of 8.6 years (1.5-13 years). The disease was staged according to Maceira, which included 3 feet in stage II, 15 feet in stage III, 7 feet in stage IV, and 6 feet in stage V. Pre- and postoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS), radiologic examination, and patients’ satisfaction rate of the surgery were evaluated at an average of 6.6 years (4-12 years) following surgery. Results: Selective arthrodesis according to various symptoms and CT-scan findings related to MWD, 12 feet had talonavicular arthrodesis, 16 feet had talonavicular-cuneiform arthrodesis, and 3 feet had triple arthrodesis. The follow-up visit showed satisfactory outcomes, solid union was achieved in all cases, with average fusion time was 15.2 weeks (12-26 weeks). VAS score reducing from the preoperative 7.8 (7-9) to postoperative 2.3(0-4), whereas the AOFAS score improved from the preoperative 25.4 (19-42) to the postoperative 80.3 (73-88). The patient’s subjective ratings showed excellent results in 8 feet, good results in 18 feet, and fair outcomes in 5 feet. Conclusion: Selective arthrodesis according to various symptoms and CT-scan findings related to MWD, 12 feet had talonavicular arthrodesis, 16 feet had talonavicular-cuneiform arthrodesis, and 3 feet had triple arthrodesis. The follow-up visit showed satisfactory outcomes, solid union was achieved in all cases, with average fusion time was 15.2 weeks (12-26 weeks). VAS score reducing from the preoperative 7.8 (7-9) to postoperative 2.3(0-4), whereas the AOFAS score improved from the preoperative 25.4 (19-42) to the postoperative 80.3 (73-88). The patient’s subjective ratings showed excellent results in 8 feet, good results in 18 feet, and fair outcomes in 5 feet.