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Die Arthrodese des Talonavikulargelenks beim rheumatischen Fuß

Talonavicular arthrodesis for the rheumatoid foot

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Zusammenfassung

Hintergrund: Beim rheumatischen Fuß stellt die fortgeschrittene Arthritis des Talonavikulargelenks eine Indikation zur talonavikularen Arthrodese dar. In der Literatur werden hierfür verschiedene Operationstechniken mit teilweiser hoher Pseudarthroserate beschrieben.

Material und Methoden: Anhand von 7 Fällen wird die Arthrodese des Talonavikulargelenks mittels Kompressionsschrauben und autologer Spongiosaplastik diskutiert. Zur klinischen Evaluation des Behandlungserfolges wurde der Belastungsschmerz des operierten Fußes präoperativ und nach 35 Monaten (3–58 Monate) ermittelt.

Ergebnisse: In allen Fällen war die Arthrodese des Talonavikulargelenks 12 Wochen postoperativ knöchern konsolidiert, bei geringer Komplikationsrate. Der Belastungsschmerz war postoperativ deutlich reduziert.

Schlussfolgerungen: Die Arthrodese des Talonavikulargelenks mittels Kompressionsschrauben und autologer Spongiosaplastik stellt ein komplikationsarmes Operationsverfahren mit hoher Fusionsrate dar.

Abstract

Background: Talonavicular joint fusion has been successfully applied for the surgical treatment of the rheumatoid foot. Several fixation techniques have been suggested for this purpose, however, with high rates of non-union.

Methods: Based on seven cases operated in our division, talonavicular joint fusion with two 3.5 mm compression screws and autologous bone grafting is discussed. Pain in the operated foot under weight-bearing conditions was assessed before surgery and after a mean follow-up of 35 months (range 3–58 months).

Results: Solid talonavicular fusion was achieved clinically and radiologically in all patients after 12 weeks. The surgery-related morbidity was low. At follow-up, weight-bearing pain was diminished compared to the preoperative status.

Conclusions: Compression screw arthrodesis of the talonavicular joint in combination with autologous bone grafting is highly successful in rheumatoid arthritis patients.

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Literatur

  1. Akagi S, Sugano H, Ogawa R (1997) The long term results of ankle joint synovectomy for rheumatoid arthritis. Clin Rheumatol (Belg) 16: 284–290

    Google Scholar 

  2. Arnett FC, Edworthy SM, Bloch DA et al. (1993) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31: 315–324

    Google Scholar 

  3. Carl HD, Putz C, Weseloh G et al. (2006) Insoles for the treatment of the rheumatoid foot. A clinical and pedobarographic evaluation. Orthopäde (in Druck)

  4. Donatto KC (1998) Arthritis and arthrodeses of the hindfoot. Clin Orthop 349: 81–92

    PubMed  Google Scholar 

  5. Felson DT (1997) Epidemiology of the rheumatic diseases. In: Koopman WJ (ed) Arthritis and allied conditions: A textbook of rheumatology, 13th edn. Wiliams & Wilkins, Baltimore, pp

  6. Haas C, Kladny B, Lott S et al. (1999) Progression of rheumatic foot deformities – a radiologic five years follow-up. Z Rheumatol 58: 351–357

    Article  PubMed  Google Scholar 

  7. Hewchuck A, Goldman F, Wargon C (1994) The Herbert™ cannulated bone screw in rearfoot arthrodesis. J Foot Ankle Surg 33: 266–270

    PubMed  Google Scholar 

  8. Jaakola J, Mann R (2004) A review of rheumatoid arthritis affecting the foot and ankle. Foot Ankle Int 25: 866–874

    PubMed  Google Scholar 

  9. Keenan MAE, Peabody TD, Gronely JK, Perry J (1991) Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis. J Bone Joint Surg Am 73: 237–247

    PubMed  Google Scholar 

  10. Kindsvater K, Wilson MG, Thomas WH (1997) Management of the rheumatoid foot with special reference to talonavicular arthrodesis. Clin Orthop 340: 69–74

    PubMed  Google Scholar 

  11. Ljung P, Kaij J, Knutson K et al. (1992) Talonavicular arthrodesis in the rheumatoid foot. Foot Ankle 13: 313–316

    PubMed  Google Scholar 

  12. Mann RA, Horten GA (1996) Management of the foot and ankle in rheumatoid arthritis. Rheum Dis Clin North Am 22: 457–476

    Article  PubMed  Google Scholar 

  13. Michelson J, Easley M, Wigley FM, Hellman D (1994) Foot and ankle problems in rheumatoid arthritis. Foot Ankle Int 15: 608–613

    PubMed  Google Scholar 

  14. Miehlke W, Gschwend N, Rippstein P, Simmen BR (1997) Compression arthrodesis of the rheumatoid ankle and hindfoot. Clin Orthop 340: 75–86

    PubMed  Google Scholar 

  15. Nassar J, Cracchiolo A III (2001) Complications in surgery of the foot and ankle in patients with rheumatoid arthritis. Clin Orthop 391: 140–152

    PubMed  Google Scholar 

  16. Sany J, Anaya JM, Canovas F et al. (1993) Influence of methotrexate on the frequency of postoperative infectious complications in patients with rheumatoid arthritis. J Rheumatol 20: 1129–1132

    PubMed  Google Scholar 

  17. Thoren K, Ljung P, Pettersson H et al. (1993) Comparison of talonavicular dowel arthrodesis utilizing autogenous bone versus defatted bank bone. Foot Ankle 14: 125–128

    PubMed  Google Scholar 

  18. Toolan BC, Hansen ST Jr (1998) Surgery of the rheumatoid foot and ankle. Curr Opinion Rheumatol 10: 116–119

    Google Scholar 

  19. Wülker N, Flamme CH, Müller A, Wirth CJ (1997) Ankle and hindfoot arthrodeses – a ten years follow-up. Z Orthop 135: 509–515

    PubMed  Google Scholar 

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  1. Orthopädisch-Rheumatologische Abteilung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Im Waldkrankenhaus St. Marien, Rathsberger Straße 57, 91054, Erlangen, Deutschland

    H.-D. Carl, D. Pfander, G. Weseloh & B. Swoboda

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  1. H.-D. Carl
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  2. D. Pfander
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  3. G. Weseloh
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  4. B. Swoboda
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Correspondence to H.-D. Carl.

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Carl, HD., Pfander, D., Weseloh, G. et al. Die Arthrodese des Talonavikulargelenks beim rheumatischen Fuß. Z. Rheumatol. 65, 633–639 (2006). https://doi.org/10.1007/s00393-006-0082-z

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