Outcome of Tibiotalocalcaneal Fusion with Retrograde Hindfoot Nail.

Abstract

Background: Tibiotalocalcaneal arthrodesis (TTCA) has been an effective surgical treatment for ankle and hindfoot deformity correction and pain relief. This paper presents the results of tibiotalocalcaneal arthrodesis using a hindfoot nail and bone grafting.

Material and methods: From November 2016 to December 2019, 15 patients underwent tibiotalocalcaneal arthrodesis with a hindfoot nail for treatment of advanced ankle and hindfoot disease. Included cases were 10 instances of end-stage arthritis characterized by severe pain, instability, and challenges in weight-bearing, 4 cases of hindfoot pain with hindfoot fusion non-union (failed arthrodesis fixation), and 1 case of Charcot arthropathy. Unilateral procedures were conducted in all instances, comprising 9 male and 6 female participants. The average age at the surgery date was 56.25 years, ranging from 45 to 63 years. The follow-up duration averaged 16 months, falling within a range of 12 to 18 months.

Results: Successful fusion was observed in all 15 cases. The average AOFAS score, with a maximum of 73 points, increased from an initial mean of 18 points (ranging from 5 to 31) to a mean of 57 points (ranging from 41 to 73), excluding stability and range of motion scores. Patient satisfaction on a scale of 10 points rose from 3 to 7 for both pain and function.

Conclusions: 1. The results of the present study suggest that TTCA using a short, retrograde intramedullary nail is a worldwide accepted technique for achieving fusion with minimal complications. However, long-term follow-up is necessary to provide definitive information about topics such as adjacent degenerative arthritis. 2. Tibiotalocalcaneal fusion with intramedullary nail (Hindfoot Nail) resulted in a higher fusion rate, no/minimal infections, lower pain levels, higher quality of life, and quicker return to work. 3. Retrograde intramedullary nailing offers a safe and reliable salvage option and a very viable alternative to amputation in patients with severe ankle and hindfoot pathologies.