4.5 Article

Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a prospective cohort study at a minimum five year follow-up

Journal

INTERNATIONAL ORTHOPAEDICS
Volume 45, Issue 9, Pages 2299-2305

Publisher

SPRINGER
DOI: 10.1007/s00264-020-04904-3

Keywords

Tibiotalocalcaneal; Arthrodesis; Charcot neuroarthropathy; Retrograde intramedullary nail; Limb salvage

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The study found that tibiotalocalcaneal (TTC) arthrodesis using a contemporary retrograde intramedullary nail led to significantly improved functional outcomes and reduced pain for patients, with high satisfaction rates and successful return to work for most patients.
Purpose To evaluate prospectively the functional outcomes of tibiotalocalcaneal (TTC) arthrodesis with a contemporary retrograde intramedullary nail after a minimum follow-up of five years. Methods Sixty-one patients with a mean age of 51.3 (range, 18-79) years were included in the study. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society Ankle Hindfoot score (AOFAS), Short-Form 12-item Health Survey (SF12), and visual analog scales (VAS) for both pain and patient satisfaction. Radiographic evaluation was also assessed. Results The mean post-operative follow-up was 6.8 (range, 5-8) years. Mean AOFAS and SF12 scores significantly improved at the final follow-up (p < 0.001), and the mean VAS for pain significantly decreased (p < 0.001). At the final follow-up, only five (8.2%) patients gave an AOFAS score of less than 50, 52 (85.2%) were satisfied with their surgery, and 32 (52.4%) returned to their employment. There were two tibiotalar joint nonunions that required re-operations, and another patient required re-operation for screw removal. There was no deep infection. Conclusions The retrograde intramedullary nail provided a stable TTC arthrodesis with a high union rate, acceptable functional outcomes, and a low severe complication rate. This procedure appears to offer a reliable salvage option for TTC arthrodesis in patients with severe ankle and hindfoot degeneration.

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