The Outcome of Extended Tarso-Metatarsal and Mid-Tarsal Midfoot Arthrodesis

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Arthrodesis of extended midfoot arthritis (more than four joints) remains surgically challenging and technically demanding due to bone loss and deformity with a goal to achieve fusion between multiple joints. Yet the outcome and fusion rate of this particular group was sparsely reported and with a lot of heterogeneity. The aim of this study is to assess the outcome of extended midfoot arthrodesis, which included a combined fusion of Tarsometatarsals, Naviculocuneiform, and/or the Talonavicular joints. METHODS: Patients who underwent extended midfoot fusion (> four joints) over ten year period (2009-2019) were identified. Only non-neuropathic patients where multiple joints midfoot fusion were performed were included, more specifically the group of patients who required combined fusion of the second and third Tarsometatarsal joints with extension to the Naviculocuneiform, the Talonavicular, and/or the first Tarsometatarsal joints. All operations were performed by the senior author through a single incision using non-locking compression lag screws and 2.7mm locking plates. Institutional review board approval was obtained to review electronic patient records and imaging. Etiology of midfoot arthritis, fusion rate, reoperation, postoperative complications, and patient satisfaction were independently evaluated. Pre-paid addressed envelopes were posted and Patient Report Outcome Measures (PROMs), including patient satisfaction, MOxFQ (Manchester Oxford Foot ) were collected, and statistical analysis was performed. RESULTS: Fifty-one patients (59 feet) out of 162 patients were included. The questionnaire response rate was 82.3%. Female: male ratio was 2.9:1 with a mean age 56.9. The most prevalent diagnosis was primary osteoarthritis in 54.2%, rheumatoid arthritis in 10.2 %, post-traumatic arthritis 17%. AVN of the navicular was the indication for surgery in 18.6%. Extension to naviculocuneiform and talonavicular joint was performed in 100% and 40.6% respectively. 73.8 % were satisfied, with a higher satisfaction rate in older age (P < 0.005) and talonavicular group (P <0.05).Total number of joints fused was 292, with a fusion rate of 95.6%. A lower fusion of the talonavicular and naviculocuneiform joints was observed at 89.8% and 79.2% respectively (Table).Other minor complications included removal of metal, metatarsals stress fracture, metatarsalgia, talonavicular arthrosis, delayed wound healing, SPN neuroma, and CRPS. Deep infection was not reported. CONCLUSION: In this series, we highlighted that extended multiple joint midfoot arthrodesis which included fusion of the naviculocuneiform or/and the talonavicular joints produced a high fusion rate when compared to the total number of joints fused, although a lower fusion rate was observed across the naviculocuneiform and talonavicular joints. Extended midfoot arthrodesis is complex; patients should be well informed and counseled about the outcome and the consequences, with a careful approach when quoting satisfaction.