Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail for Charcot neuroarthropathy of foot - A prospective observational study

Background: Surgical treatment is often needed for Charcot neuroarthropathy (CN) of foot. Even though good outcomes were reported with tibiotalocalcaneal arthrodesis (TTCA) in CN patients, the choice of implant is still an issue. The aim of the study was to evaluate the outcomes of TTCA with retrograde intramedullary nail, in patients with CN. Materials and methods: A prospective observational study was done with 41 consecutive patients treated with TTCA with hindfoot retrograde IM nail. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for the outcome evaluation, one year after surgery. Results: The mean age was 67.4(±8.7) years, with 63.5% females. Most common cause was diabetes mellitus (75.6%), followed by post-traumatic CN (19.5%) and chronic alcoholism (4.9%). Eleven (26.8%) had good score at the end of 1 year compared to five (12.2%) pre-op and twenty (48.8%) had fair score compared to fifteen (36.6%). The AOFAS score increased one year after surgery (p value 0.001). In twenty (48.8%) patients, the time taken for union was more than 6 months; and in 15 (36.6%) union occurred within 6 months of surgery. Six (14.6%) patients had non-union. Two (4.9%) had deep infection along with non-union. Hardware failure was seen in 3 (7.3%) patients. Hardware failure with non-union was reported in one (2.4%). Four (9.8%) patients had superficial wound infection and amputation done in one (2.4%) patient. Conclusion: Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail is an acceptable and safe procedure with good clinical outcomes in patients with Charcot arthropathy which obviates the need for amputation. Keywords: Charcot neuroarthropathy; tibiotalocalcaneal arthrodesis; intramedullary nail; amputation