Review Article | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 90-98 | Vivek Maurya, Girish Motwani, Ankit Jaiswal, Sachin Kale

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.788

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 25 Jul 2025, Review Date:18 Aug 2025, Accepted Date: 05 Sep 2025 & Published Date: 10 Dec 2025

Author: Vivek Maurya [1], Girish Motwani [1], Ankit Jaiswal [1], Sachin Kale [2]

[1] Department of Orthopaedics, Suyog Hospital, Nagpur, Maharashtra, India.
[2] Department of Orthopaedics, Dr D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Vivek Maurya,
Department of Orthopaedics, Suyog Hospital, Nagpur, Maharashtra, India.
E-mail: vivek.vom@gmail.com

Abstract

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.

References

1. Molina WF, Gushiken E, Martins GB, Heitzmann LG, Pimenta LS, Fonseca ED, et al. Müller-Weiss disease: The state of the art. J Foot Ankle 2024;18:156-65.
2. Angthong C, Younger ASE, Chuckpaiwong B, Harnroongroj T, Veljkovic A. A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm. Cartilage. 2024 Mar;15(1):65-71. doi: 10.1177/19476035231205684. Epub 2023 Oct 18. PMID: 37850567; PMCID: PMC10985398.
3. Mohamed Z, Msakni A, Boussetta R, Mohseni AA, Nessib MN. Primary subacute hematogenous osteomyelitis of navicular bone: A rare case report in 7-year-old child. Ann Med Surg 2021;71:102911.
4. Cristofaro C., “Clinical Features and Differential Diagnosis of Müller-Weiss Disease,” Foot and Ankle Clinics, vol. 29, no. 3, 2024, p. S1083-7515(24)00215-8.
5. Kitaura Y, Nishimura A, Nakazora S, Fukuda A, Senga Y, Kato K, et al. Spontaneous osteonecrosis of the tarsal navicular: A report of two cases. Case Rep Orthop 2019;2019:5952435.
6. Adams SB, Danilkowicz RM. Talonavicular joint-sparing 3D printed navicular replacement for osteonecrosis of the navicular. Foot Ankle Int 2021;42:1197-204.
7. Claes L, Eckert-Hübner K, Augat P. The fracture gap size influences the local vascularization and tissue differentiation in callus healing. Langenbecks Arch Surg 2003;388:316-22.
8. Kadakia RJ, Wixted CM, Allen NB, Hanselman AE, Adams SB. Clinical applications of custom 3D printed implants in complex lower extremity reconstruction. 3D Print Med 2020;6:29.
9. Ahmed AA, Kandil MI, Tabl EA, Elgazzar AS. Müller-Weiss disease: A topical review. Foot Ankle Int 2019;40:1447-57.
10. Pei, Y., Zhu, L., Xu, Q., Wang, J., Sun, Y. & Wang, G. (2024). Clinical report of microsurgical treatment of Kohler’s disease. Scientific Reports, 14, Article 6341.
11. Wong-Chung J., Blythe A., Lynch-Wong M., McKenna R., Wilson A., Stephens M. Outcomes of Selective Arthrodesis Based on Joints Affected in 33 Feet With Müller-Weiss Disease. Journal of Foot & Ankle Surgery. 2024 Mar-Apr; 63(2):199-206.
12. Higgs, Z., & Senthil Kumar, C. “Principles of Arthrodesis Surgery in Müller–Weiss disease – The Scottish Experience.” Foot & Ankle Clinics, 2025 Apr 4. DOI: 10.1016/j.fcl.2024.08.008.
13. Bai W, Li Y, Shen G, Zhang H, Li X, Zhu Y. Talonavicular-cuneiform arthrodesis for the treatment of Müller-Weiss: Mid-term results of 15 cases after 5 years. BMC Musculoskelet Disord 2023;24:178.
14. So E, Mandas VH, Hlad L. Large osseous defect reconstruction using a custom three-dimensional printed titanium truss implant. J Foot Ankle Surg 2018;57:196-204.
15. Freibott CE, Shoap SC, Evangelista MC, Vosseller JT, Greisberg JK. Graft Collapse and Loss of Fixation in Lateral Column Lengthening. Foot Ankle Orthop. 2019 Nov 1;4(4):2473011419S00177. doi: 10.1177/2473011419S00177. PMCID: PMC8696428.
16. Bulut, HI, Okay E, Onay T, Kanay E, Ozkan K. Innovative approaches to cage reconstructions in orthopedic limb surgery: Advances and insights with two cases. Surg Case Rep 2024;3:100073.
17. Patil SD, Kakkar RS, Saxena S, Patil PD. Reconstruction of large midfoot bone loss using titanium spinal mesh cage with bone graft: A case report. Orthoplastic Surg 2022;9:106-10
18. Noble DM, Small B, Cooper MT, Park JS, Perumal V. Porous Titanium Wedges in Revision First Metatarsophalangeal Arthrodesis. Foot Ankle Orthop. 2022 Jan 21;7(1):2473011421S00378. doi: 10.1177/2473011421S00378. PMCID: PMC8794974.
19. Uzer G, Demirel M, Kara D, Toker B, Yildiz F, Ucan V. Talonavicular-cuneiform arthrodesis in the management of Mueller-Weiss syndrome: A retrospective case series. Acta Orthop Belg 2024;90:154-9.
20. Cao HH, Lu WZ, Tang KL. Isolated talonavicular arthrodesis and talonavicular-cuneiform arthrodesis for the Müller-Weiss disease. J Orthop Surg Res 2017;12:83.

 (Article Text HTML)  (Download PDF)