Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sabine K, Sascha A, Peter B, Clemens M, Michel C, Hans-Joerg T (2017) Comparative study of outcomes after ankle arthrodesis shows higher complication rates in cases operated upon by general orthopaedic surgeons. Int Orthop 41:1163–1168. https://doi.org/10.1007/s00264-017-3459-5

    Article  PubMed  Google Scholar 

  2. Anderson T, Linder L, Rydholm U, Montgomery F, Besjakov J, Carlsson A (2005) Tibio-talocalcaneal arthrodesis as a primary procedure using a retrograde intramedullary nail: a retrospective study of 26 patients with rheumatoid arthritis. Acta Orthop 76:580–587. https://doi.org/10.1080/17453670510041592

    Article  PubMed  Google Scholar 

  3. Richter M, Zech S (2016) Tibiotalocalcaneal arthrodesis with a triple-bend intramedullary nail (A3): 2-year follow-up in 60 patients. Foot Ankle Surg 22:131–138. https://doi.org/10.1016/j.fas.2015.06.005

    Article  PubMed  Google Scholar 

  4. Franceschi F, Franceschetti E, Torre G, Papalia R, Samuelsson K, Karlsson J, Denaro V (2016) Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:1316–1325. https://doi.org/10.1007/s00167-015-3548-1

    Article  PubMed  Google Scholar 

  5. Lee BH, Fang C, Kunnasegaran R, Thevendran G (2018) Tibiotalocalcaneal arthrodesis with the hindfoot arthrodesis nail: a prospective consecutive series from a single institution. J Foot Ankle Surg 57:23–30. https://doi.org/10.1053/j.jfas.2017.05.041

    Article  PubMed  Google Scholar 

  6. Biz C, Hoxhaj B, Aldegheri R, Iacobellis C (2016) Minimally invasive surgery for tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail: preliminary results of an innovative modified technique. J Foot Ankle Surg 55:1130–1138. https://doi.org/10.1053/j.jfas.2016.06.002

    Article  PubMed  Google Scholar 

  7. Budnar VM, Hepple S, Harries WG, Livingstone JA, Winson I (2010) Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail. Foot Ankle Int 31:1085–1092. https://doi.org/10.3113/FAI.2010.1085

    Article  PubMed  Google Scholar 

  8. Carranza-Bencano A, Tejero S, Del Castillo-Blanco G, Fernández-Torres JJ, Alegrete-Parra A (2014) Minimal incision surgery for tibiotalocalcaneal arthrodesis. Foot Ankle Int 35:272–284. https://doi.org/10.1177/1071100713515447

    Article  CAS  PubMed  Google Scholar 

  9. Dalla Paola L, Volpe A, Varotio D, Postorino A, Brocco E, Senesi A, Merico M, De Vido D, Da Ros R, Assaloni R (2007) Use of a retrograde nail for ankle arthrodesis in charcot neuropathy: a limb salvage procedure. Foot Ankle Int 28:967–790. https://doi.org/10.3113/FAI.2007.0967

    Article  PubMed  Google Scholar 

  10. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M, Lutter LD (1994) Clinical rating systems for the ankle-hindfoot, hallux, and lesser toes. Foot Ankle Int 15:349–355. https://doi.org/10.1177/107110079401500701

    Article  CAS  PubMed  Google Scholar 

  11. Ware JE Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  PubMed  Google Scholar 

  12. Thomas AE, Guyver PM, Taylor JM, Czipri M, Talbot NJ, Sharpe IT (2015) Tibiotalocalcaneal arthrodesis with a compressive retrograde nail: a retrospective study of 59 nails. Foot Ankle Surg 21:202–205. https://doi.org/10.1016/j.fas.2015.01.001

    Article  CAS  PubMed  Google Scholar 

  13. Alfahd U, Roth SE, Stephen D, Whyne CM (2005) Biomechanical comparison of intramedullary nail and blade plate fixation for tibiotalocalcaneal arthrodesis. J Orthop Trauma 19:703–708. https://doi.org/10.1097/01.bot.0000184142.90448.e3

    Article  PubMed  Google Scholar 

  14. Schneider W, Jurenitsch S (2016) Normative data for the American Orthopedic Foot and Ankle Society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system. Int Orthop 40:301–306. https://doi.org/10.1007/s00264-015-3066-2

    Article  PubMed  Google Scholar 

  15. Schwienbacher S, Aghayev E, Hofmann UK, Jordan M, Marmotti A, Röder C, Ipach I (2015) Driving and emergency braking may be impaired after tibiotalar joint arthrodesis: conclusions after a case series. Int Orthop 39:1335–1341. https://doi.org/10.1007/s00264-015-2789-4

    Article  PubMed  Google Scholar 

  16. Lucas Y Hernandez J, Abad J, Remy S, Darcel V, Chauveaux D, Laffenetre O (2015) Tibiotalocalcaneal arthrodesis using a straight intramedullary nail. Foot Ankle Int 36:539–546. https://doi.org/10.1177/1071100714565900

    Article  PubMed  Google Scholar 

  17. Jehan S, Shakeel M, Bing AJ, Hill SO (2011) The success of tibiotalocalcaneal arthrodesis with intramedullary nailing: a systematic review of the literature. Acta Orthop Belg 77:644–651

    PubMed  Google Scholar 

  18. Mulhern JL, Protzman NM, White AM, Martin SM, Fleming JJ, Clements JR, Brigido SA (2016) Is subtalar joint cartilage resection necessary for tibiotalocalcaneal arthrodesis via intramedullary nail? A multicenter evaluation. J Foot Ankle Surg 55:572–577. https://doi.org/10.1053/j.jfas.2015.11.007

    Article  PubMed  Google Scholar 

  19. Taylor J, Lucas DE, Riley A, Simpson GA, Philbin TM (2016) Tibiotalocalcaneal arthrodesis nails: a comparison of nails with and without internal compression. Foot Ankle Int 37:294–299. https://doi.org/10.1177/1071100715611891

    Article  PubMed  Google Scholar 

  20. Fenton P, Bali N, Matheshwari R, Youssef B, Meda K (2014) Complications of tibio-talar-calcaneal fusion using intramedullary nails. Foot Ankle Surg 20:268–271. https://doi.org/10.1016/j.fas.2014.07.002

    Article  CAS  PubMed  Google Scholar 

  21. Mendicino RW, Catanzariti AR, Saltrick KR, Dombek MF, Tullis BL, Statler TK, Johnson BM (2004) Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing. J Foot Ankle Surg 43:82–86. https://doi.org/10.1053/j.jfas.2004.01.012

    Article  PubMed  Google Scholar 

  22. Siebachmeyer M, Boddu K, Bilal A, Kavarthapu V (2015) Outcome of one stage correction of deformities of ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail. Bone Joint J 97-B:76–82. https://doi.org/10.1302/0301-620X.97B1.34542

    Article  CAS  PubMed  Google Scholar 

  23. Ajis A, Tan KJ, Myerson MS (2013) Ankle arthrodesis vs TTC arthrodesis: patient outcomes, satisfaction, and return to activity. Foot Ankle Int 34:657–665. https://doi.org/10.1177/1071100713478929

    Article  PubMed  Google Scholar 

  24. Coughlin MJ, Grimes JS, Traughber PD, Jones CP (2006) Comparison of radiographs and CT scans in the prospective evaluation of the fusion of hindfoot arthrodesis. Foot Ankle Int 27:780–787. https://doi.org/10.1177/107110070602701004

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ankle and Foot Unit, Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax, s/n. 03600, Elda, Alicante, Spain

    Adolfo Perez-Aznar, Blanca Gonzalez-Navarro, Laiz L. Bello-Tejeda & Alejandro Lizaur-Utrilla

  2. Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain

    Carolina Alonso-Montero, Alejandro Lizaur-Utrilla & Fernando A. Lopez-Prats

Authors
  1. Adolfo Perez-Aznar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Blanca Gonzalez-Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laiz L. Bello-Tejeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carolina Alonso-Montero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alejandro Lizaur-Utrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fernando A. Lopez-Prats
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alejandro Lizaur-Utrilla.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consents were required by the institutional review board.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perez-Aznar, A., Gonzalez-Navarro, B., Bello-Tejeda, L.L. et al. Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a prospective cohort study at a minimum five year follow-up. International Orthopaedics (SICOT) 45, 2299–2305 (2021). https://doi.org/10.1007/s00264-020-04904-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04904-3

Keywords

Search

Navigation