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Subtalar arthroereisis
Subtalar arthroereisis can be the first procedure
for many patients with varying degrees of
flexible flatfoot pathology. It is a practical
option to correct painful flexible flatfoot when
other non-surgical treatments have failed, both in
pediatric and adult patients.
Subtalar arthroereisis
Arthroereisis is defined
as the limitation of
exogenous joint motion
without complete
arthrodesis using
specialized implants.
Subtalar implants
Vogler Biomechanical Classification
classified the implants as
A axis-altering prosthesis,
B impact-blocking device or
C self-locking wedge
Subtalar Implants
Subtalar Implants
- Since 1976
one of the first
in use
- UHMWPE
- Platform in
sinus tarsi to
elevate subtalar
joint
- Stem in
calcaneal bone
Subtalar Implants
- UHMWPE
- Angled disk &
peg design
- Angled disk to
block the talus
movement
- Softened edges
to reduce the
possibility of
wear
particulate
- Cannulated for
accurate
insertion
Subtalar Implants
- Titanium
- Concaved distal
entrance into guide
wire opening to
allow self centering
of guide pin for
removal
- More aggressive
first thread for
easier insertion
Subtalar Implants
Mostly Metallic
Also Bioabsorbable
Arthrex
ProStop
-Initially PLLA,
avoiding the
need for
secondary
implant
removal
Surgical technique
- Minimally
incision
- Insertion of
guide-wire
Surgical technique
Fluoroscopic control of
position and size
Surgical technique
Surgical technique
Results
Radiographic data and subjective results have been
promising for both pediatrics and adults.
Reviewing case series data within the past decade
revealed a satisfaction rate ranging from 81% to 90% for
pediatrics and 78% to
89% reported for adult patients
Some mechanical
complications
Anterior Displacement
of a too small implant
surgeon error
Some mechanical
complications
Pain in the
sinus tarsi
requiring
removal of
the implant
implant
related
problem
Conclusions
Subtalar arthroereisis is a relatively simple but
not necessarily un complicated procedure.
With correct indications and associated
surgical techniques, long term clinical results
can be very effective.
Some studies discuss that current width and
length of
the commercially available especially
cylindrically shaped implants may need to be
modified!
Even bioabsorbable implants may still require
removal surgery!