From the Research
Triple hemiarthrodesis is a surgical procedure that fuses three joints in the foot—the talonavicular, calcaneocuboid, and subtalar joints—to correct severe foot deformities and provide stability, and the procedure should be performed with meticulous preoperative planning and precise surgical technique to minimize complications, as highlighted in the study by 1. The procedure begins with patient positioning in the supine or lateral position under general or regional anesthesia.
- After sterile preparation, the surgeon makes two incisions:
- a lateral incision over the sinus tarsi for subtalar and calcaneocuboid joint access,
- and a dorsomedial incision for the talonavicular joint. The surgeon then identifies and exposes each joint, carefully protecting neurovascular structures.
- Using osteotomes, curettes, and rongeurs, the surgeon removes the articular cartilage from each joint surface until bleeding subchondral bone is exposed. The foot is then positioned in the corrected alignment, typically with neutral hindfoot valgus/varus, slight external rotation, and appropriate forefoot positioning relative to the hindfoot.
- Temporary K-wires may be used to maintain this alignment. The surgeon then applies bone graft (autograft from iliac crest or local sources) to the prepared joint surfaces to promote fusion.
- Definitive fixation is achieved using screws, staples, or plates across each joint. The surgeon confirms proper alignment with fluoroscopy before wound closure in layers. Postoperatively, the patient typically remains non-weight bearing for 6-12 weeks in a cast or boot, followed by progressive weight bearing in a protective boot and physical therapy, as supported by the study by 2. This procedure is particularly effective for patients with severe flatfoot deformities, posterior tibial tendon dysfunction, or rigid cavovarus deformities that have not responded to conservative treatment, as it provides long-term stability by eliminating motion at these key joints while preserving some midfoot flexibility, as noted in the study by 3. However, it is essential to be aware of potential complications, such as nonunion or painful pseudoarthrosis, and to carefully evaluate the patient's preoperative condition to minimize the risk of long-term problems, as emphasized in the study by 4. It is also crucial to consider the patient's overall health and potential risk factors, such as those identified in the study by 5, although this study is not directly related to triple hemiarthrodesis. Overall, triple hemiarthrodesis is a valuable surgical option for patients with severe foot deformities, and its success depends on careful preoperative planning, precise surgical technique, and thorough postoperative care, as highlighted in the most recent and highest-quality study by 1.