Differential efficacy of subtalar fusion with three operative approaches

BACKGROUND: There are many existing operative approaches for subtalar fusion; however, no optional strategy of operative approach has been developed yet. This study aimed to analyze the differential clinical efficacy of subtalar fusion with three operative approaches. METHODS: The clinical data of 102 patients from April 2008 to April 2012 were analyzed prospectively. These patients were divided into three groups with the random number table: group A, group B, and group C. The following parameters were compared among three groups: effective exposure area and exposure time of subtalar joint, intraoperative bleeding volume, postoperative complications, fusion time, fusion rate, AOFAS score and VAS score before and after operation. RESULTS: In the exposure area score, there was no statistically significant difference between group A and group C (P >0.05) ,but with a statistically significant difference between group A/C and group B (P <0.05). In exposure time and intraoperative bleeding volume, there was no statistically significant difference between group A and group B (P >0.05) but with a statistically significant difference between group A/B and group C (P <0.05). In three groups, there was a statistically significant difference in both AOFAS score and VAS score before operation and at 6 months/12 months/last visit after operation (P <0.05). The incidence of complications in the three groups was 8.8%, 12.5% and 19.4%. No statistically significant differences in fusion rate and fusion time were observed among the three groups (P >0.05). CONCLUSION: Three operative approaches have different indications, All the three operative approaches do not influence the fusion rate and fusion time of subtalar joint. The lateral tarsal sinus approach is inferior to the posterior-lateral L approach and the approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone in the exposure area, while the lateral tarsal sinus approach and the approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone are superior to the posterior-lateral L approach in the exposure time, intraoperative bleeding volume, and incidence of complications. LEVEL OF EVIDENCE: Therapeutic, level III.