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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 post-traumatic 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.