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Arthroereisis is a minimally invasive surgical procedure used to treat conditions such as flatfoot by inserting an implant into the sinus tarsi, a space between the talus and calcaneus bones in the foot. The implant limits excessive subtalar joint movement and corrects hindfoot deformities associated with flat feet. Arthroereisis offers several advantages over traditional open surgery, including smaller incisions, shorter recovery times, and preservation of natural foot anatomy and biomechanics. This reversible technique can be easily removed if necessary, making it an attractive option for patients and clinicians. Participating in this course offers clinicians a comprehensive understanding of arthroereisis techniques, patient selection criteria, and perioperative management strategies. Clinicians will gain proficiency in implant placement and postoperative care, enabling them to address flatfoot deformities and related complications effectively. Additionally, clinicians will learn about multidisciplinary collaboration and communication strategies to facilitate coordinated care and ensure patient safety throughout treatment. Objectives: Identify appropriate candidates for arthroereisis based on clinical presentation, radiographic findings, and functional limitations. Differentiate between flexible and rigid flatfoot deformities to determine the suitability of arthroereisis as a treatment option. Assess postoperative outcomes and monitor patients for complications, including pain, implant migration, and wound healing. Collaborate with interdisciplinary team members, including orthopedic surgeons, physical therapists, and podiatrists, to provide comprehensive care for patients undergoing arthroereisis. Access free multiple choice questions on this topic.

The term "arthroereisis" comes from the combination of the Greek words arthro- (joint) and -ereisis (the action of bracing against or pushing against something).[1] Arthroereisis refers to a surgical procedure used to treat flatfoot, aiming to reestablish a medial foot arch and limit but not completely block subtalar joint movement from going into eversion.[2] In 1946, Chambers initially introduced the concept of "manipulation" of the subtalar joint to address flatfoot. This involved the impaction of a wedge-shaped bone block into the anterior border of the posterior facet of the calcaneus, a procedure known as an "abduction block," which prevents excessive forward displacement of the talus upon the calcaneus.[3] A few years later, Baker and Hill advocated a lateral opening-wedge osteotomy of the posterior joint surface to achieve the same goal.[4] Haraldsson was the first to coin the term "arthrohisis" to describe the insertion of a wedge graft into the sinus tarsi.[5][6] In 1970, Lelièvre first used the term "arthroereisis" to describe a similar technique involving the insertion of a bone graft into the sinus tarsi, secured with a temporary staple.[7] The concept of supporting the talus on the calcaneus by inserting an external synthetic implant in the sinus tarsi quickly evolved. In 1974, Subotnick proposed the first device to achieve this, and since then, various solutions have been introduced, differing in form (block, sphere, screw, cap, cylinder) and composition (polyethylene, silastic, titanium, or a combination of these).[8][9]

Complications of arthroereisis can be broadly categorized into 4 groups: Implant biomaterial failure (screw loosening, wear, or breakage) Inflammatory reaction (painful sinus tarsitis, peroneal spasm, stiff equinus or fourth metatarsal stress fracture) Technical error (extrusion, malcorrection, overcorrection, or undercorrection) Those related to use in contraindicated cases (unstable midtarsal joint, arthritis, rigid equinus) [34][35] The most common complication associated with arthroereisis is pain around the sinus tarsi, although this typically resolves upon implant removal.[36] However, there is uncertainty regarding complication and removal rates. As a recent literature analysis indicates, reported complication rates range from 4.8% to 18.6%, while removal rates range from 7.1% to 19.3%.[37] These figures contradict many authors' observations that not all complications require additional surgery and may resolve spontaneously. Earlier studies showed that up to 40% of patients needed implant removal.[38] However, the lack of long-term follow-up and comprehensive analyses underscores the need for thorough prospective research in the future. Furthermore, case reports have outlined a few rare but potentially severe issues, such as talar fracture and postoperative subtalar fusion. Recent studies, however, indicate a relatively low overall complication rate, ranging from 0% to 11%. Despite this, a 2015 web-based survey revealed surprising data indicating that 33% of American Orthopedic Foot and Ankle Society members who had previously conducted subtalar arthroereisis opted to discontinue the procedure due to its high failure rate and the need for implant removal.[22] This suggests that research on subtalar arthroereisis may be influenced by publication bias, favoring the reporting of positive outcomes. Additionally, the survey states that a greater share of foreign surgeons performs arthroereisis than their American counterparts, potentially influenced by challenges in payment from health insurance companies.[22]

Furthermore, case reports have outlined a few rare but potentially severe issues, such as talar fracture and postoperative subtalar fusion. Recent studies, however, indicate a relatively low overall complication rate, ranging from 0% to 11%. Despite this, a 2015 web-based survey revealed surprising data indicating that 33% of American Orthopedic Foot and Ankle Society members who had previously conducted subtalar arthroereisis opted to discontinue the procedure due to its high failure rate and the need for implant removal.[22] This suggests that research on subtalar arthroereisis may be influenced by publication bias, favoring the reporting of positive outcomes. Additionally, the survey states that a greater share of foreign surgeons performs arthroereisis than their American counterparts, potentially influenced by challenges in payment from health insurance companies.[22] Previous research suggests that implants should remain in place for at least 2 years for proper bone and soft tissue adaptation before removal.[39] Delays of 6 to 18 months have been noted in older literature, particularly when used as an adjunct surgery for adult flatfoot to capitalize on the impact of the implant on other surgical operations.[8] However, there is no precise timeframe for permanent repair. Studies investigating predictors of implant removal in adults indicate significant unplanned explantation rates of up to 30% to 40%. Risk factors include radiographic undercorrection of deformity and larger implant size.[40] In these studies, arthroereisis was often performed as an adjunct operation with various implant types. However, older literature suggests that a higher removal rate does not always correlate with size and radiographic parameters of correction. Establishing a precise correlation between explantation risk and potential risk factors is still necessary.

Effective management of arthroereisis requires a collaborative approach involving various healthcare professionals to optimize patient-centered care, outcomes, and safety. Physicians, advanced practitioners, nurses, pharmacists, and other team members must possess the necessary skills and expertise to perform their respective roles effectively. Surgeons need expertise in arthroereisis techniques, including implant placement and postoperative management. Advanced practitioners are crucial in patient assessment, education, and follow-up care, ensuring treatment plans are tailored to individual needs. Nurses provide essential support in perioperative care, monitoring patients for complications and facilitating their recovery. Pharmacists contribute by ensuring appropriate medication management, including pain control and prevention against infection. Physical therapists guide postoperative rehabilitation efforts. Interprofessional communication is vital for care coordination and optimizing patient outcomes. Healthcare professionals must communicate effectively to exchange information, coordinate treatment plans, and promptly address concerns or complications. Regular multidisciplinary team meetings can facilitate collaboration, allowing each member to contribute their expertise and insights. Clear communication channels enhance patient safety by minimizing errors and ensuring all team members align with the treatment goals. Additionally, ongoing education and training programs help healthcare professionals stay updated on the latest advancements in arthroereisis techniques and patient care, further enhancing team performance and patient outcomes.