Novel Bone and Marrow Harvesting Approach Through Posterior Subtalar Screw Tunnel for Revision Talonavicular Joint Arthrodesis

We present a case report of revision talonavicular joint arthrodesis following painful nonunion. Following the removal of the previously united subtalar joint arthrodesis hardware, the posterior screw tunnel was used to access the internal aspect of the calcaneus for bone and marrow harvesting avoiding a second graft site incision. A suction curettage system was then used to acquire adequate autologous cancellous bone graft and nondiluted bone marrow. The talonavicular joint was then prepared for revision arthrodesis, followed by augmentation with the autologous cancellous bone graft and rigid internal fixation placed across the joint for compression. There were no complications noted at the donor site or the arthrodesis site immediately following surgery or during follow-up. Radiographs obtained 4 months postoperatively demonstrate osseous union at the talonavicular joint and near complete consolidation at the calcaneal donor site. The patient is currently walking pain-free in a walking boot and will be continually followed to allow for long-term outcome measures.