COMPARISON OF TALONAVICULAR DOWEL ARTHRODESIS UTILIZING AUTOGENOUS BONE VERSUS DEFATTED BANK BONE

A simple dowel arthrodesis of the talonavicular joint in an early stag e of destruction can reduce pain and prevent the development of valgus deformity in the rheumatoid hindfoot. Previously, we used autogenous dowels made from the iliac crest. In order to facilitate the operation and to get a better fitting dowel, we tried defatted cancellous allog raft dowels from which marrow tissue had been removed. The dowels were prepared from femoral heads in our surgical bone bank. At operation, the dowels were embedded in fresh marrow aspirate from the iliac crest and the arthrodeses were stabilized with a staple. Results were evalu ated by clinical examination and radiography. The results of four pati ents were compared with an earlier study of eight patients using autog enous dowels taken from the iliac crest. With both techniques, the pat ients were relieved of pain in the talonavicular joint, but some had p ain from other hindfoot joints. With autogenous dowels, all eight pati ents healed with radiographic bony union, but with allogenous dowels, the four patients developed fibrotic nonunion. The results indicate th at talonavicular arthrodesis should be made using only autologous dowe ls.