Retrospective Review of Double vs Triple Hindfoot Arthrodesis: Clinical and Radiographic Comparison

Abstract

Category: Hindfoot; Other Introduction/Purpose: Triple arthrodesis of the subtalar, talonavicular, and calcaneocuboid joints is a commonly performed procedure to treat hindfoot deformity. Debate exists regarding the need to include the calcaneocuboid joint in the arthrodesis, leading some surgeons to perform double arthrodesis of the subtalar and talonavicular joints to treat similar pathology. Differences in clinical, radiographic and patient reported outcomes between the two procedures have not been thoroughly reported. The purpose of this study is to evaluate the clinical and radiographic outcomes of double versus triple arthrodesis for the correction of symptomatic hindfoot deformity. Methods: A retrospective cohort study reviewed all patients who underwent double or triple arthrodesis to correct hindfoot pathology between January 2016 and April 2019 at our institution. Patients were identified using CPT codes. Inclusion criteria included patients greater than 18 years old who underwent hindfoot correction by a primary double or triple arthrodesis with a minimum 3 month clinical and radiographic follow up. Exclusion criteria included prior hindfoot arthrodesis and peripheral neuropathy. The primary outcome was union at each arthrodesis site. Secondary outcomes included deformity correction, operative times, re-operation rates, complications, and patient reported outcomes. Chi-squared or Fisher’s Exact tests were used as appropriate to compare categorical variables and t-tests were used to compare numerical variables. Results: One hundred fourteen procedures met inclusion criteria. There were 86 double (75%) and 28 triple arthrodeses (25%). Eleven talonavicular non-unions were identified in the double arthrodesis group (12.7%) compared to 5 in the triple arthrodesis group (17.9%, p =0.54). There were 2 (7.1%) calcaneocuboid non-unions in the triple group. Subtalar arthrodesis was achieved 100% in both groups. Operative time was shorter for doubles compared to triples, but this did not reach statistical significance (104 min vs 117 min, p = 0.089). The only deformity correction parameter to reach significance was post operative cuboid height being higher in the double group (19.1mm vs 16.7mm, p = 0.012). Pre-operative deformity, overall union rates, reoperation rate, and post operative complications were not statistically different between the two procedures. Conclusion: In this study double arthrodesis was shown to result in shorter operative times with similar deformity correction, union rates, and post operative complications when compared to triple arthrodesis. The double arthrodesis is a viable alternative to treat hindfoot pathology. More research is warranted to further compare the long term outcomes between the two procedures.