Archives of Orthopaedic and Trauma Surgery - 2026-03-28 - Journal Article
Minimally invasive versus open talonavicular arthrodesis: comparable functional outcomes in a retrospective comparative cohort.
Werneburg F, Arbab D, Zeh A, Delank KS, Gutteck N
Topics
Key Takeaway
MIS and open talonavicular arthrodesis produced equivalent AOFAS gains (36.2 vs. 30.9 points) at mean 361-day follow-up with no significant difference in operative time (59.2 vs. 69.6 min).
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Summary
This retrospective cohort compared functional outcomes of MIS (n=32) versus open (n=24) talonavicular arthrodesis using AOFAS ankle-hindfoot score as the primary endpoint. Both groups demonstrated substantial improvement: MIS AOFAS 53.2→89.4 versus open 56.9→87.7, with no statistically significant between-group difference (p=0.853, Cohen's d=0.15). One symptomatic nonunion requiring revision occurred in the open group versus zero in MIS, though the event rate was insufficient to draw comparative safety conclusions (p=0.389).
Key Limitation
The sample size of 56 feet is underpowered to detect meaningful differences in complication and nonunion rates, which are the outcomes most likely to differ between approaches.
Original Abstract
BACKGROUND
Talonavicular (TN) arthrodesis is an established procedure for symptomatic TN joint pathology and medial column dysfunction. Open techniques provide direct visualization but may be associated with approach-related soft-tissue morbidity. Minimally invasive surgery (MIS) has been proposed to reduce tissue disruption; however, comparative clinical evidence focusing on functional outcomes remains limited. This study compared functional outcomes between MIS and open TN arthrodesis.
METHODS
This retrospective cohort study included 56 feet (55 patients) treated with TN arthrodesis between January 2021 and January 2025. Thirty-two feet underwent MIS TN arthrodesis and 24 feet an open approach. The primary endpoint was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score assessed preoperatively and at final follow-up. Secondary endpoints were operative time and complications. Radiographic follow-up was performed as part of routine care to assess osseous fusion and to guide postoperative rehabilitation.
RESULTS
Mean follow-up was 361 ± 69 days. Functional outcomes improved substantially in both groups. Mean AOFAS increased from 53.2 ± 17.6 to 89.4 ± 9.5 in the MIS group (mean gain 36.2 ± 13.3) and from 56.9 ± 14.5 to 87.7 ± 12.7 in the open group (mean gain 30.9 ± 9.1). Between-group differences were not significant for postoperative AOFAS ( p = 0.853; Cohen’s d = 0.15) or operative time (59.2 ± 35.6 vs. 69.6 ± 35.1 min; p = 0.415). No complications were documented in the MIS cohort; one patient in the open cohort developed symptomatic nonunion requiring revision (between-group comparison p = 0.389).
CONCLUSION
In this retrospective comparative cohort, MIS and open TN arthrodesis were associated with substantial and comparable functional improvement at short-to-midterm follow-up. Complications were uncommon overall; the low event rate precludes firm conclusions regarding comparative safety or nonunion risk. MIS may be considered when soft-tissue preservation is prioritized, and future prospective studies with standardized protocols and PROM-based outcomes are needed.
LEVEL OF EVIDENCE
III.