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. 2021 Sep;45(9):2299-2305.
doi: 10.1007/s00264-020-04904-3. Epub 2021 Jan 14.

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

Adolfo Perez-Aznar  1 , Blanca Gonzalez-Navarro  1 , Laiz L Bello-Tejeda  1 , Carolina Alonso-Montero  2 , Alejandro Lizaur-Utrilla  3   4 , Fernando A Lopez-Prats  2
Affiliations

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

Adolfo Perez-Aznar et al. Int Orthop. 2021 Sep.

Abstract

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.

Keywords: Arthrodesis; Charcot neuroarthropathy; Limb salvage; Retrograde intramedullary nail; Tibiotalocalcaneal.

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