What Rates to Quote for Your Hindfoot Fusions?

by Vince Vacketta, DPM

As we have entered an era of more routine CT imaging, every surgeon’s new favorite tool is now delivering some hard truths regarding union rates. A recent systematic review from Leslie et al. evaluated 1,301 joints across 26 studies of hindfoot and ankle arthrodesis and demonstrated a 78.7% union rate when CT analysis was performed. Furthermore, when looking at joint-specific union rates, including TN, STJ, ankle, and TTC, the authors failed to find a single joint that had a CT-reported union rate greater than 90%. The talonavicular joint was the best at healing in this review.

But what is considered "healed"

In their study, Glazebrook et al. showed patients with CT-verified osseous bridging of 25% to 49% across the fused joint had clinical improvement based on the SF-12, Foot Function Index, and AOFAS, whereas those with <25% osseous bridging did not. This study suggests our goal is 50% volumetric healing.

Next Steps

We need another study to compare PROs with volume of fusion to validate the Glazebrook 50% fusion guideline. In the meantime, biologic augmentation of hindfoot fusions is undeniably the recommendation.