Outcome After Operative Fusion of the Tarsal Joints: A Systematic Review


      Arthrodesis of 1 or more joints of the hindfoot is performed to treat severe functional impairment due to pain, deformity, and/or instability. Evaluation of the results of hindfoot arthrodesis from the published data has been difficult owing to the great variety of pathologic entities and surgical techniques reported in the studies. A comprehensive search for relevant reports, reference lists, and citation tracking of the included studies was conducted using the PubMed®, Embase®, and CINAHL® databases. The studies had to have been prospective, included patients with hindfoot problems, evaluated arthrodesis of 1 or more tarsal joints, and had at least 1 of the following primary clinical outcome parameters: pain, function, or complications. Two of us independently selected the relevant studies using predefined criteria and graded the quality of evidence using a 0 to 9 star scale according to the Newcastle-Ottawa Scale. A total of 16 prospective case series were included; 5 studies scored 6 stars, 8 scored 5 stars, 2 scored 4 stars, and 1 scored 3 stars. A best evidence synthesis was performed, and improvement in function and pain was found for 3 combinations: talonavicular arthrodesis for rheumatoid arthritis, triple arthrodesis for rheumatoid arthritis, and subtalar arthrodesis for post-traumatic arthritis showed good results for pain and function, the last especially when performed arthroscopically. The best evidence syntheses revealed good results for pain and function for these disease-operative technique combinations.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Figgie M.P.
        • O’Malley M.J.
        • Ranawat C.
        • Ingles A.E.
        • Sculco T.P.
        Triple arthrodesis in rheumatoid arthritis.
        Clin Orthop Relat Res. 1993; 292: 250-254
        • Bennet G.L.
        • Graham C.E.
        • Mauldin D.M.
        Triple arthrodesis in adults.
        Foot Ankle. 1991; 12: 138-143
        • Graves S.C.
        • Mann R.A.
        • Graves K.O.
        Triple arthrodesis in older adults: results after long-term follow up.
        J Bone Joint Surg Am. 1993; 75: 355-362
        • Popelka S.
        • Hromádka R.
        • Vavrík P.
        • Stursa P.
        • Pokorný D.
        • Jahoda D.
        • Sosna A.
        Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction.
        BMC Musculoskelet Disord. 2010; 11: 38
        • Lechler P.
        • Graf S.
        • Kock F.X.
        • Schaumburger J.
        • Grifka J.
        • Handel M.
        Arthrodesis of the talonavicular joint using angle stable mini plates: a prospective study.
        Int Orthop. 2012; 36: 2491-2494
        • van der Krans A.
        • Louwerens J.W.
        • Anderson P.
        Adult acquired flexible flatfoot, treated by calcaneocuboid distraction arthrodesis, posterior tibial tendon augmentation, and percutaneous Achilles tendon lengthening: a prospective outcome study of 20 patients.
        Acta Orthop. 2006; 77: 156-163
        • Chen Y.J.
        • Huang T.J.
        • Hsu K.Y.
        • Hsu R.W.
        • Chen C.W.
        Subtalar distractional realignment arthrodesis with wedge bone grafting and lateral decompression for calcaneal malunion.
        J Trauma. 1998; 45: 729-737
        • Eid M.A.
        • El-Soud M.A.
        • Mahran M.A.
        • El-Hussieni T.F.
        Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft.
        Strategies Trauma Limb Reconstr. 2010; 5: 39-45
        • Garras D.N.
        • Santangelo J.R.
        • Wang D.W.
        • Easley M.E.
        Subtalar distraction arthrodesis using interpositional structural allograft.
        Foot Ankle Int. 2008; 29: 561-567
        • Coughlin M.J.
        • Smith B.W.
        • Traughber P.
        The evaluation of the healing rate of subtalar arthrodeses, part 2: the effect of low-intensity ultrasound stimulation.
        Foot Ankle Int. 2008; 29: 970-977
        • Cracchiolo III, A.
        • Pearson S.
        • Kitaoka H.
        • Grace D.
        Hindfoot arthrodesis in adults utilizing a dowel graft technique.
        Clin Orthop Rel Res. 1990; 257: 193-203
        • Easley M.E.
        • Trnka H.J.
        • Schon L.C.
        • Meyerson M.S.
        Isolated subtalar arthrodesis.
        J Bone Joint Surg Am. 2000; 82: 613-624
        • Elsner A.
        • Barg A.
        • Stufkens S.A.
        • Hintermann B.
        Lambrinudi arthrodesis with posterior tibialis transfer in adult drop-foot.
        Foot Ankle Int. 2010; 31: 30-37
        • Fellmann J.
        • Zollinger H.
        Isolated talocalcaneal interposition fusion: a prospective follow-up study.
        Foot Ankle Int. 1997; 18: 616-621
        • Zollinger H.
        • Fellmann J.
        Die talokalkaneare interpositionsarthrodese.
        Oper Orthop Traumatol. 2004; 2: 152-166
        • Boack D.H.
        • Manegold S.
        • Friedebold A.
        • Haas N.P.
        Arthroscopic in situ arthrodesis of the subtalar joint.
        Orthopäde. 2005; 34: 1245-1254
        • Glanzmann M.C.
        • Sanhueza-Hernandez R.
        Arthroscopic subtalar arthrodesis for symptomatic osteoarthritis of the hindfoot: a prospective study of 41 cases.
        Foot Ankle Int. 2007; 28: 2-7
        • Lee K.B.
        • Park C.H.
        • Seon J.K.
        • Kim M.S.
        Arthroscopic subtalar arthrodesis using a posterior 2-portal approach in the prone position.
        Arthroscopy. 2010; 26: 230-238
      1. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Health Research Institute; 1999.

        • Slavin R.E.
        Best evidence synthesis: an intelligent alternative to meta-analysis.
        J Clin Epidemiol. 1995; 48: 9-18
        • Kitaoka H.B.
        • Alexander I.J.
        • Adelaar R.S.
        • Nunley J.A.
        • Myerson M.S.
        • Sanders M.
        Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.
        Foot Ankle Int. 1994; 15: 349-353
        • Ibrahim T.
        • Beiri A.
        • Azzabi M.
        • Best A.J.
        • Taylor G.J.
        • Menon D.K.
        Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.
        J Foot Ankle Surg. 2007; 46: 65-74
        • Budiman-Mak E.
        • Conrad K.J.
        • Roach K.E.
        The foot function index: a measure of foot pain and disability.
        J Clin Epidemiol. 1991; 44: 561-570
        • Johnson K.
        Arthrodesis of the foot and ankle.
        in: Surgery of the Foot and Ankle. Raven Press, New York1989: 151-181
        • Wessel J.
        The reliability and validity of pain threshold measurements in osteoarthritis of the knee.
        Scand J Rheumatol. 1995; 24: 238-242
        • Feiwell L.A.
        • Cracchiolo III, A.
        The use of internal fixation in performing triple arthrodesis in adults.
        Foot. 1994; 4: 10-14
        • Abu-Faraj Z.O.
        • Harris G.F.
        • Smith P.A.
        Surgical rehabilitation of the planovalgus foot in cerebral palsy.
        IEEE Trans Neural Syst Rehabil Eng. 2001; 9: 202-214