TIBIOTALOCALCANEAL ARTHRODESIS IN RHEUMATOID ARTHRITIS USING THE SUPRACONDYLAR NAIL

Abstract

Introduction and Aims: Numerous internal as well as external fixation techniques have been reported for achieving tibiotalocalcaneal fusion in rheumatoid arthritis with varying results. The purpose of this study was to assess the union rate and functional outcome following tibiotalocalcaneal fusion using the locked supracondylar nail.

Method: Twenty-four patients (27 ankles) were followed up. The mean age being 57 years (44–73 years) and mean follow-up was 37.4 months (10–74 months). Severe disabling ankle pain was the indication for operation in all cases. Standard operative technique and post-operative mobilisation protocol was followed. Seventeen cases had ankle debridement. The severity of rheumatoid arthritis was assessed using the Fries scoring system. Results were analysed using Rheumatoid ankle score (RAS), modified American Orthopaedic Foot & Ankle Society Score (AOFAS). All the patients were evaluated for clinical and radiological evidence of union.

Results: The mean Fries score of 2.3 suggest that most of the patients in the study group were affected by severe rheumatoid arthritis. The mean RAS score was 77 (35–95) and mean AOFAS score was 74.6 (40–95). Using the rheumatoid ankle scoring system, five ankles (20%) were rated excellent, ten ankles (40%) were rated good, six ankles (24%) were rated fair and four (16%) were rated poor. In general, patients who had ankle debridement at the time of nailing fared well in terms of clinical, radiological union and ankle scoring.

Conclusion: Tibiotalocalcaneal arthrodesis with supracondylar nail in rheumatoid arthritis provides pain-free stable joint and satisfactory functional outcome. Better functional results are achieved with bony union and this can be achieved only with joint debridement.