Partial excision of navicular and extended triple arthrodesis and bone grafting for Müller-Weiss disease

Z. Higgs, G. Chalmers, C.S. Kumar

Introduction: Isolated talonavicular fusion is often associated with failure for the treatment of Müller-Weiss disease of the navicular. This is mainly due to inadequate viable bone in navicular for a talonavicular fusion. Both triple arthrodesis and talo-naviculo-cuneiform fusions have been reported to yield better results. We present the results of an "extended" triple arthrodesis procedure, modified to include partial or sub-total excision of the diseased navicular and bone grafting.

Methods: A retrospective review of case notes and radiographs of all patients who underwent extended triple arthrodesis between 2007-2015 was performed. The lateral one-third or the lateral half of the navicular was excised in all patients and a tricortical iliac crest or a block allograft from a femoral head was used to bridge the talus to the cuneiforms.

Results: Twelve operations were performed in 11 patients. There were 4 men and 7 women with a mean age of 49 years (range 20-69 years). Seven primary (58%) and 5 revision (42%) procedures were performed. Mean follow-up was 13 months (range 10-67 months). There was evidence of clinical and/or radiological union at the latest follow-up in all patients. Two patients underwent removal of metalwork (17%). One patient had delayed wound healing (8%). There were no revisions and no cases of infection.

Conclusion: Extended triple fusion appears to be an effective procedure for the treatment of Müller-Weiss disease; excision of the diseased navicular and replacement with bone graft gives a predictable rate of success in these complex cases.