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Realignment Arthrodesis of the Rearfoot and Ankle

A Comprehensive Evaluation

Robert W. Mendicino Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Pittsburgh. Dr. Lamm is now at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.

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Bradley M. Lamm Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Pittsburgh. Dr. Lamm is now at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.

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Alan R. Catanzariti Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Pittsburgh. Dr. Lamm is now at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.

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Trenton K. Statler Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Pittsburgh. Dr. Lamm is now at the Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.

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Dror Paley Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.

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Ankle and tibiotalocalcaneal arthrodeses are performed for the treatment of painful, arthritic, unstable, and deformed rearfoot and ankle joints. Surgical complications are not uncommon (~30%); some can be attributed to poor preoperative planning and inadequate intraoperative position. Several authors have attempted to define the optimal position for ankle arthrodesis without objective multiplanar radiographic analysis and consistent reference points. This investigation explored the effects of ankle and tibiotalocalcaneal realignment arthrodeses on static lower-extremity position in 20 patients. The most common preoperative diagnosis was severe degenerative joint disease following ankle fractures and ankle instability. Seven tibiotalocalcaneal arthrodeses and 13 isolated ankle arthrodeses were performed (mean follow-up, 22 months). Average time to radiographic osseous union of the isolated ankle and tibiotalocalcaneal arthrodeses was 11 and 7 weeks, respectively. Medical complications occurred in 2 patients (10%). There were no statistically significant differences between preoperative and postoperative angular relationships. This study objectively quantifies multiplanar foot-to-leg realignment and defines the optimal clinical and radiographic positions for ankle and tibiotalocalcaneal realignment arthrodeses. (J Am Podiatr Med Assoc 95(1): 60–71, 2005)

Corresponding author: Robert W. Mendicino, DPM, Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, 4800 Friendship Ave, North Tower, First Floor, Pittsburgh, PA 15224.
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