Arthroereisis technique

current materials and implant

design
Botezatu I , Marinescu R,
Laptoiu D
Colentina Clinical Hospital
Bucharest

Subtalar arthroereisis
Subtalar arthroereisis can be the first procedure
for many patients with varying degrees of
flexible flatfoot pathology. It is a practical
option to correct painful flexible flatfoot when
other non-surgical treatments have failed, both in
pediatric and adult patients.

Subtalar arthroereisis
Arthroereisis is defined
as the limitation of
exogenous joint motion
without complete
arthrodesis using
specialized implants.

This procedure, which

involves placing a
motion blocking
implant within the
sinus tarsi, has been
designed to restrict
excessive subtalar joint
(STJ) pronation while
preserving supination .

Subtalar implants
Vogler Biomechanical Classification
classified the implants as
A axis-altering prosthesis,
B impact-blocking device or
C self-locking wedge

Subtalar Implants

Subtalar Implants

- Since 1976
one of the first
in use
- UHMWPE
- Platform in
sinus tarsi to
elevate subtalar
joint
- Stem in
calcaneal bone

Subtalar Implants

- UHMWPE
- Angled disk &
peg design
- Angled disk to
block the talus
movement
- Softened edges
to reduce the
possibility of
wear
particulate
- Cannulated for
accurate
insertion

Subtalar Implants

- Titanium
- Concaved distal
entrance into guide
wire opening to
allow self centering
of guide pin for
removal
- More aggressive
first thread for
easier insertion

Bioabsorbable Barrel Design

Subtalar Implants

Mostly Metallic

Also Bioabsorbable
Arthrex
ProStop
-Initially PLLA,
avoiding the
need for
secondary
implant
removal

Special implants the

design

- One-piece titanium alloy

- Intended to block the forward,
downward, and medial
displacement of the talus, thus
allowing normal subtalar joint
motion but limiting excessive
pronation.
- The spherical shape mitigates
potential lateral pressure points
- Deep pitch distal anchor thread
for canalis tissue engagement
- Trestle structure with up to 75
micro channels designed for
intention of quicker tissue
integration to reduce implant
migration

Special implants the

expandables

Surgical technique

- Minimally
incision
- Insertion of
guide-wire

Surgical technique

Fluoroscopic control of
position and size

Surgical technique

Surgical technique

Results
Radiographic data and subjective results have been
promising for both pediatrics and adults.
Reviewing case series data within the past decade
revealed a satisfaction rate ranging from 81% to 90% for
pediatrics and 78% to
89% reported for adult patients

Needleman RL. A surgical approach for flexible flatfeet

in adults including a subtalar arthroereisis with the MBA
sinus tarsi implant. Foot Ankle Int 2006;27:9.
Koning PM, Heesterbeek PJ, de Visser E. Subtalar
arthroereisis for pediatric flexible pes planovalgus:
fifteen years experience with the cone-shaped implant.
J Am Podiatr Med Assoc 2009;99:447
Viladot R, Pons M, Alvarez F, et al. Subtalar
arthroereisis for posterior tibial tendon dysfunction: a
preliminary report. Foot Ankle Int 2003;24:600

Some mechanical
complications
Anterior Displacement
of a too small implant
surgeon error

Some mechanical
complications
Pain in the
sinus tarsi
requiring
removal of
the implant
implant
related
problem

Some material problems

Fragmentation of
PLLA implant at
several years postimplantation still
requiring removal
surgery

Some material problems

Synovitis with
UHMWPE

Conclusions
Subtalar arthroereisis is a relatively simple but
not necessarily un complicated procedure.
With correct indications and associated
surgical techniques, long term clinical results
can be very effective.
Some studies discuss that current width and
length of
the commercially available especially
cylindrically shaped implants may need to be
modified!
Even bioabsorbable implants may still require
removal surgery!