A comprehensive review of subtalar arthrodesis

Background: The aim of this study was to evaluate the results of a series of subtalar arthrodeses done by a single surgeon using a standard technique. Methods: A retrospective review of 95 primary isolated subtalar arthrodeses in 92 patients was done. Original diagnoses included post-traumatic subtalar arthrosis, primary osteoarthrosis, talocalcaneal coalition, and inflammatory joint disease. In all arthrodeses, a single 7.0-mm partially-threaded cancellous screw was used for fixation, and autogenous bone graft was used. Structural iliac crest autograft was required to restore heel height in three feet with posttraumatic arthrosis. In these three, autograft was harvested from the iliac crest with the remainder receiving morcellized autograft either from the tibia, fibula, or calcaneus. Results: No patients were lost to followup. Ninety-five percent (87) of patients went on to bony union radiographically. Using the Angus and Cowell rating system, 93% (88 feet) of patients had a good or fair outcome. There were seven poor results: four arthrodeses failed to unite, two patients had persistent hindfoot pain in spite of radiographic union, and one developed post-traumatic ankle arthrosis. Conclusions: The results of isolated subtalar arthrodesis using a single screw for fixation are comparable to other fixation methods. Bone graft from local sites obviates the need for iliac crest autograft in most patients.