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Perinavicular Arthrodesis as Treatment of Advanced Navicular Osteonecrosis

Ahmad, Jamal MD

Techniques in Foot & Ankle Surgery: June 2015 - Volume 14 - Issue 2 - p 79–87
doi: 10.1097/BTF.0000000000000090
Special Focus: Innovative Techniques in Foot and Ankle Surgery, Part I
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Osteonecrosis of the navicular is known as Muller-Weiss disease (MWD). In its advanced stages, MWD renders patients with severe perinavicular (PN) arthritis, pain, and dysfunction. Current surgical treatment options are limited by scant literature about this condition. This text describes a novel means of treating advanced MWD with a PN arthrodesis. This procedure involves a combined dorsal approach to the talonavicular (TN) and naviculocuneiform (NC) and lateral approach to the calcaneocuboid (CC) joints. As cartilage is removed from the TN, NC, and CC joints to achieve fusion, all necrotic portions of the navicular are excised and replaced with structural autologous iliac crest bone graft. A dorsal plate-and-screw construct (ALPS) is used to fuse the TN and NC joints. Staples (Stapilizer) are used to fuse the CC joints. To date, the author (J.A.) has performed 10 PN arthrodeses in 10 patients with MWD and achieved good clinical and radiographic results. Fusion was achieved in all 10 patients (100%) on radiographs by a mean time to fusion of 16.8 weeks. All patients experienced improved function and less pain at their latest follow-up. Postoperative complications include 1 delayed union of the PN fusion. To date, no patients have developed adjacent joint arthritis. Treatment of advanced MWD in this manner has not been previously reported in the orthopedic literature. As MWD is studied further, this surgical technique should be strongly considered as treatment.

Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.

Department of Orthopaedic Surgery, Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA

The author declares no conflict of interest.

Address correspondence and reprint requests to Jamal Ahmad, MD, Department of Orthopaedic Surgery, Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107. E-mail: jamal.ahmad@rothmaninstitute.com.

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