Introduction: Synchronous severe arthrosis of the ankle and subtalar joints is a debilitating problem that can be difficult to treat. Tibiotalocalcaneal arthrodesis remains the treatment of choice for this disabling condition. There are many techniques described for ankle arthrodesis, some of which are not applicable to patients with severe rheumatoid arthritis due to osteopenia and/or deformity. Minimally invasive procedures are preferable in this population, whose wound-healing ability is often compromised. This study aims to show the reliability and success of intra-medullary nailing for ankle arthrodesis. We also wished to assess postoperative pain relief and quality of life.

Methods: We reviewed 15 patients who had undergone tibiotalocalcaneal fusion with a retrograde intramedullary nail. Patients were assessed clinically and radiologically. Outcome measures included radiological union, ankle and foot function and quality of life, pre and postoperatively. The “ankle and foot function score” was used to assess function. Quality of life scores were obtained using the Short Form 36 (v2) pre and postoperatively. Statistical analysis was performed using the paired Student t-test.

Results: Indications for ankle arthrodesis were rheumatoid arthritis (n=11) and posttraumatic arthritis (n=4). Mean follow up was 11.2 months. Mean time to fusion was 2.9 months +/− 0.85. Solid fusion was achieved in 14 out of 15 patients (93%), one patient having a failed fusion due to persistent wound complications. There was an improvement in both the ankle and foot function scores and in the physical parameters of the SF-36 postoperatively. The mean preoperative ankle and foot function score was 26.7 +/− 13.5 versus 37 +/− 16 postoperatively (p=0.25). In assessing quality of life, the mean physical functioning score was 20.9 +/− 4 versus 29.1 +/− 10.4 postoperatively (p=0.08). Role limitations due to physical problems scored 26.3 +/− 5.3 preoperatively versus 32.7 +/− 10.9 postoperatively (p=0.09). Overall, there was a significant difference in pre and post-op mean summary physical component score: 27.5 +/− 4.9 versus 35 +/− 8.9, p=0.049.

Conclusion: This well tolerated, minimally invasive technique provides a surgical solution for a challenging clinical problem. Overall, this procedure improved both physical function and quality of life in our series and achieved a fusion rate equivalent to published series. We would advocate this procedure as a highly effective technique in the treatment of advanced rheumatoid hindfoot arthritis.