Interpositional Arthroplasty of the Calcaneocuboid Joint Using a Regenerative Tissue Matrix to Treat Recurrent Nonunion


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Abstract

abstractFull article available online at OrthoSuperSite.com/view.asp?rID=36008Nonunion after foot arthrodesis is a difficult clinical problem to solve. This article presents a case of a patient who underwent 3 unsuccessful attempts at calcaneocuboid joint arthrodesis. This problem was salvaged with interpositional arthroplasty of the joint with successful clinical outcome.A 49-year-old woman with longstanding rheumatoid arthritis underwent triple hindfoot arthrodesis. Although the talonavicular joint and the talocalcaneal joints achieved successful arthrodesis, the calcaneocuboid joint did not unite. Revision arthrodesis of the joint, as well as another attempt at percutaneous grafting had failed. Infection was ruled out by biopsy. In each instance, her postoperative course was complicated by difficulty complying with nonweight bearing restrictions, changes in her rheumatoid arthritis medications, and medical comorbidities. Considering all of her medical and rehabilitation issues, she underwent interpositional arthroplasty using a regenerative tissue matrix, rather than a fourth attempt at arthrodesis. Allograft dermal matrix was used as interpositional material at the calcaneocuboid joint. One year postoperatively, the patient reports only mild discomfort in the hindfoot, which does not interfere with her activities of daily living.In the difficult setting of multiple failed attempts at arthrodesis, interpositional arthroplasty can be considered in a nonweight-bearing joint such as the calcaneocuboid joint. Interpositional arthroplasty represents a technique capable of providing pain relief in clinical situations in which osseous union cannot be achieved.

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