Abstract
Tibiotalocalcaneal arthrodeisis is performed for a variety of conditions, including advanced osteoarthritis, Charcot arthropathy, rheumatoid arthritis, post-traumatic arthrosis and foot deformities such as fixed equinovarus. There have been few published studies showing the results of such a procedure for limb salvage.
Over a period of 11 years between 1996 and 2007, 18 patients underwent calcaneotalotibial arthrodeisis using either cannulated screws or a retrograde intramedullary locking nail. Post-operative rehabilitation regimes were standardised. VAS, AOFAS ankle-hindfoot, SF-36 and patient satisfaction scores were obtained and analysed.
Eighteen patients (10 male and 8 female) with 19 ankles underwent tibiotalocalcaneal arthrodeisis at an average age of 52.3 (31.4 to 70.2 years). Seven patients had cavovarus deformity, six had osteoarthritis, three had Charcot's joint, two had failed previous fusions and one patient had a footdrop post-T12 tumour resection. Twelve right and seven left fusions were performed, with six cannulated screws and 13 retrograde nails. The mean time to complete fusion was 5.89 (3 to 11) months in 18 ankles (94.7%). There was one pseudoarthrosis (5.3%). Patients were followed up for an average of 35.6 (11 to 144) months. Four wound infections (21%) occurred post-operatively. Two patients died from unrelated caused whilst on follow-up.
Thriteen patients returned for follow-up scoring. VAS scores improved from 7.85 to 2.54 (p=0.00). AOFAS ankle-hindfoot scores improved from 30.50 to 63.62 (p=0.00). SF-36 scores also improved in several parameters. Physical function improved from 40.38 to 66.15 (p=0.02); physical role improved from 15.38 to 53.85 (p=0.03); Bodily pain improved from 36.69 to 62.23 (p=0.00); emotional role improved from 69.23 to 100 (p=0.04); and mental health improved from 62.77 to 0.15 (p=0.04). Eleven patients (84.6%) reported good to excellent satisfaction and expectation scores.
Hindfoot arthrodesis, via retrograde imtramedullary nailing or cannulated screw insertion, are effective techniques for treating complex foot deformities and often is the only alternative to amputation. Although a demanding procedure with high potential complications, they provide effective relief from pain, improves the quality of life, and has high patient satisfaction.
