A Novel Technique of Talo-Cuneiform Arthrodesis Using Metallic Cage in Navicular Avascular Necrosis: A Short-term Retrospective Cohort Study of Three Cases

Background: Avascular necrosis (AVN) of the navicular is a rare but debilitating condition that frequently results in collapse of the medial column and extensive bone loss in later stages. These structural deficits pose a major challenge for achieving reliable fusion with conventional techniques using just bone graft. This study dwells into the use of metallic cage to achieve talo-cuneiform arthrodesis as an alternative to conventional techniques allowing restoration of medial column alignment, maintenance of length, and provision of stable support to facilitate union in cases with substantial osseous defects. Materials and Methods: This is a clinical, retrospective study, conducted at our institution from March 2021 to March 2024 on 3 patients with AVN of navicular. Diagnosis was made on radiographs and/or magnetic resonance imaging as well as clinical examination. Surgical fixation was individualized with the use of titanium metallic cages to fill the osseous defect and patients followed up for a mean period of 50 weeks (range: 49–50 weeks). Functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score as well as Foot and Ankle Outcome Score (FAOS). Radiological stability was assessed using weight-bearing radiographs on follow-up visits. Results: The mean AOFAS, FAOS score improved from 48.7 and 42.3 preoperatively to 84.7 and 86 postoperatively indicating a significant improvement (P < 0.05) in functional outcomes. All patients had stable plantigrade foot and radiological stability after a mean 50 weeks follow-up. Conclusion: The combination of titanium cages, autologous bone grafts, and angular stable screw-plate systems appears to offer a promising alternative to conventional surgical techniques for managing navicular AVN. This method ensures medial column length preservation and provides a stable environment for arthrodesis. Based on our study, we believe that this approach could be more effective than traditional methods, offering a better prognosis for patients with idiopathic AVN (Muller–Weiss syndrome), post-traumatic arthritis, or large bone defects following navicular neoplasm resection. Keywords: Avascular necrosis of navicular, Navicular neoplasm, Talo-cuneiform arthrodesis, Muller–Weiss syndrome, Osseous defect.