Research Article| Volume 62, ISSUE 1, P68-74, January 2023

Download started.


Short-Term Risk Factors for Subtalar Arthrodesis After Primary Tibiotalar Arthrodesis

Published:April 09, 2022DOI:


      While adjacent joint arthritis is a recognized long-term downside of primary tibiotalar arthrodesis (TTA), few studies have identified risk factors for early subtalar arthrodesis (STA) after TTA. This study aims to identify the risk factors for STA within the first few years following TTA. All patients older than 18 years undergoing TTA between 2008 and 2016 were identified retrospectively. Demographic data and comorbidities were collected alongside prior operative procedures, postoperative complications, and subsequent STA. Pre-and postoperative Kellgren-Lawrence osteoarthritis grade of the subtalar joint and postoperative radiographic alignment were obtained. A total of 240 patients who underwent primary TTA were included in this study with median follow up of 13.8 months. Twenty patients (8.3%) underwent STA after TTA due to symptomatic nonunion of TTA in 13 (65%), progression of symptomatic subtalar osteoarthritis (OA) in 4 (20%), and symptomatic nonunion of primary TTA combined progressively symptomatic subtalar OA in 2 (10%). Preoperative radiographic subtalar OA severity and postoperative radiographic alignment were not correlated with subsequent STA. Diabetes mellitus, Charcot arthropathy, neuropathy, alcohol use, substance use disorder, and psychiatric disease were significantly associated with having a subsequent STA. The most common postoperative contributing factor for subsequent STA following primary TTA was the salvage of symptomatic ankle nonunion rather than subtalar joint disease. Patients considering an ankle fusion should be counseled of the risk of subsequent STA, especially if they have risk factors that include diabetes, Charcot arthropathy, neuropathy, alcohol use, substance use disorder, or psychiatric disease.

      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


        • Lin SS
        • Yeranosian MG.
        What's new in foot and ankle surgery.
        J Bone Joint Surg Am. 2016; 18: 874-880
        • Lenz AL
        • Nichols JA
        • Roach KE
        • Foreman KB
        • Barg A
        • Saltzman CL
        • Anderson AE
        Compensatory motion of the subtalar joint following tibiotalar arthrodesis: an in vivo dual-fluoroscopy imaging study.
        J Bone Joint Surg Am. 2020; 102: 600-608
        • DeSutter C
        • Dube V
        • Ross A
        • Boyd G
        • Morash J
        • Glazebrook M.
        Preliminary experience with SPECT/CT to evaluate periarticular arthritis progression and the relationship with clinical outcome following ankle arthrodesis.
        Foot Ankle Int. 2020; 41: 392-397
        • Coester LM
        • Saltzman CL
        • Leupold J
        • Pontarelli W.
        Long-term results following ankle arthrodesis for post-traumatic arthritis.
        J Bone Jt Surg - Ser A. 2001; 83: 219-228
        • Easley ME
        • Montijo HE
        • Wilson JB
        • Fitch RD
        • Nunley JA.
        Revision tibiotalar arthrodesis.
        J Bone Jt Surg - Ser A. 2008; 90: 1212-1223
        • Chraim M
        • Recheis S
        • Alrabai H
        • Wenzel-Schwarz F
        • Trnka HJ
        • Bock P.
        Midterm outcome of subtalar joint revision arthrodesis.
        Foot Ankle Int. 2021; 42: 824-832
        • Jain SK
        • Tiernan D
        • Kearns SR.
        Analysis of risk factors for failure of arthroscopic ankle fusion in a series of 52 ankles.
        Foot Ankle Surg. 2016; 22: 91-96
        • Kraus VB
        • Kilfoil TM
        • Hash TW
        • McDaniel G
        • Renner JB
        • Carrino JA
        • Adams S
        Atlas of radiographic features of osteoarthritis of the ankle and hindfoot.
        Osteoarthrits Cartilage. 2015; 23: 2059-2085
        • Dagneaux L
        • Moroney P
        • Maestro M.
        Reliability of hindfoot alignment measurements from standard radiographs using the methods of Meary and Saltzman.
        Foot Ankle Surg. 2019; 25: 237-241
        • Neri T
        • Barthelemy R
        • Tourné Y.
        Radiologic analysis of hindfoot alignment: comparison of Méary, long axial, and hindfoot alignment views.
        Orthop Traumatol Surg Res. 2017; 103: 1211-1216
        • Strasser NL
        • Turner NS.
        Functional outcomes after ankle arthrodesis in elderly patients.
        Foot Ankle Int. 2012; 33: 699-703
        • Pedowitz DI
        • Kane JM
        • Smith GM
        • Saffel HL
        • Comer C
        • Raikin SM.
        Total ankle arthroplasty versus ankle arthrodesis: a comparative analysis of arc of movement and functional outcomes.
        Bone Jt J. 2016; 98: 634-640
        • Stavrakis AI
        • SooHoo NF.
        Trends in complication rates following ankle arthrodesis and total ankle replacement.
        J Bone Jt Surg - Am Vol. 2016; 98: 1453-1458
        • Giza E
        • Sarcon AK
        • Kreulen C.
        Tibiotalar nonunion corrected by hindfoot arthrodesis.
        Foot Ankle Spec. 2010; 3: 76-79
        • Narayana Gowda BS
        • Mohan Kumar J
        Outcome of ankle arthrodesis in posttraumatic arthritis.
        Indian J Orthop. 2012; 46: 317-320
        • Thomas R
        • Daniels TR
        • Parker K.
        Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis.
        J Bone Jt Surg - Ser A. 2006; 88: 526-535
        • Zanolli DH
        • Nunley JA
        • Easley ME.
        Subtalar fusion rate in patients with previous ipsilateral ankle arthrodesis.
        Foot Ankle Int. 2015; 36: 1025-1028
        • El-Mowafi H
        • Abulsaad M
        • Kandil Y
        • El-Hawary A
        • Ali S.
        Hybrid fixation for ankle fusion in diabetic charcot arthropathy.
        Foot Ankle Int. 2018; 39: 93-98
        • Perlman MH
        • Thordarson DB.
        Ankle fusion in a high risk population: an assessment of nonunion risk factors.
        Foot Ankle Int. 1999; 20: 491-496
        • Xu B
        • Chen L
        • Lee JH.
        Smoking and alcohol drinking and risk of non-union or delayed union after fractures: a protocol for systematic review and dose-response meta-analysis.
        Medicine (Baltimore). 2020; 99: e18744
        • Chen CY
        • Lane HY
        • Lin CH.
        Effects of antipsychotics on bone mineral density in patients with schizophrenia: gender differences.
        Clin Psychopharmacol Neurosci. 2016; 14: 238-249
        • Kim WC
        • Shaffer JW
        • Idzikowski C.
        Failure of treatment of ununited fractures of the carpal scaphoid. The role of non-compliance.
        J Bone Joint Surg Am. 1983; 65: 985-991
        • Sokolowski M
        • Krähenbühl N
        • Wang C
        • Zwicky L
        • Schweizer C
        • Horn Lang T
        • Hintermann B
        Secondary subtalar joint osteoarthritis following total ankle replacement.
        Foot Ankle Int. 2019; 40: 1122-1128
        • DiGiovanni CW
        • Lin SS
        • Daniels TR
        • Glazebrook M
        • Evangelista P
        • Donahue R
        • Beasley W
        • Baumhauer JF
        The importance of sufficient graft material in achieving foot or ankle fusion.
        J Bone Jt Surg Am. 2016; 98: 1260-1267