Abstract
Introduction
Tibiocalcaneal (TC) arthrodesis is a limb salvage method for patients with severe deformities combined with necrosis and/or luxation of the talus. The aim of this study was to examine the clinical and radiological outcome of TC arthrodesis.
Materials and methods
This retrospective study identified 12 patients with luxation and/or necrosis of the talus, due to charcot neuroarthropathy (83.3 %) or traumatic injuries (16.7 %). All patients underwent TC arthrodesis by an external fixator or nail arthrodesis. The mean follow up was 18 (6–36) months with a mean age of 51.3 (30–66) years. The data were collected using the AOFAS score as well as clinical and radiological examination during regular follow up.
Results
Seven (58.3 %) patients were treated with an external fixator, four (33.3 %) with nail arthrodesis and one (8.3 %) patient rejected both fixation methods. Four (100 %) patients achieved radiological and clinical bone union after nail arthrodesis and four (57.1 %) patients after external fixation. Three (42.9 %) patients treated by an external fixator showed a radiological moderate bone fusion, but a stable, asymptomatic non-union. One (8.3 %) case ended up in transfemoral amputation. Eleven patients (91.7 %) regained independent mobilization. The mean AOFAS score improved from 24.3 preoperatively to 66.7 postoperatively (p < 0.05). The postoperative satisfaction rate was good to excellent in 83.3 %.
Conclusion
TC arthrodesis is a promising and effective method for the treatment of severe ankle deformities with talus luxation. It allows patient’s return to mobility with good to excellent patient satisfaction.
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References
Ochman S, Evers J, Raschke MJ, Vordemvenne T (2012) Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss. J Foot Ankle Surg 51:675–679. doi:10.1053/j.jfas.2012.04.015
Hammett R, Hepple S, Forster B, Winson I (2005) Tibiotalocalcaneal (hindfoot) arthrodesis by retrograde intramedullary nailing using a curved locking nail. The results of 52 procedures. Foot Ankle Int 26:810–815
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. doi:10.1080/17453670510041592
Caravaggi C, Cimmino M, Caruso S, Dalla Noce S (2006) Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot. J Foot Ankle Surg 45:20–24. doi:10.1053/j.jfas.2005.10.003
Pinzur MS, Noonan T (2005) Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. Foot Ankle Int 26:545–549
Pinzur MS (2007) Current concepts review: charcot arthropathy of the foot and ankle. Foot Ankle Int 28:952–959. doi:10.3113/FAI.2007.0952
Cinar M, Derincek A, Akpinar S (2010) Tibiocalcaneal arthrodesis with posterior blade plate in diabetic neuroarthropthy. Foot Ankle Int 31:511–516. doi:10.3113/FAI.2010.0511
Mirzayan R, Early SD, Matthys GA, Thordarson DB (2001) Single-stage talectomy and tibiocalcaneal arthrodesis as a salvage of severe, rigid equinovarus deformity. Foot Ankle Int 22:209–213
Zgonis T, Stapleton JJ, Jeffries LC, Girard-Powell VA, Foster LJ (2008) Surgical treatment of Charcot neuropathy. AORN journal 87:971–986 (quiz 987–990)
Caravaggi CM, Sganzaroli AB, Galenda P, Balaudo M, Gherardi P, Simonetti D, Ferraresi R, Farnetti A, Morandi A (2012) Long-term follow-up of tibiocalcaneal arthrodesis in diabetic patients with early chronic Charcot osteoarthropathy. J Foot Ankle Surg 51:408–411. doi:10.1053/j.jfas.2012.04.007
Fabrin J, Larsen K, Holstein PE (2007) Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus. Int J Low Extrem Wounds 6:102–107. doi:10.1177/1534734607302379
Rochman R, Jackson Hutson J, Alade O (2008) Tibiocalcaneal arthrodesis using the Ilizarov technique in the presence of bone loss and infection of the talus. Foot Ankle Int 29:1001–1008. doi:10.3113/FAI.2008.1001
Dalla Paola L, Volpe A, Varotto 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 neuroarthropathy: a limb salvage procedure. Foot Ankle Int 28:967–970. doi:10.3113/FAI.2007.0967
Siebachmeyer M, Boddu K, Bilal A, Hester TW, Hardwick T, Fox TP, Edmonds M, Kavarthapu V (2015) Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail. Bone Joint J 97-B:76–82. doi:10.1302/0301-620X.97B1.34542
Kostuj T, Krummenauer F, Schaper K, Stief F, Zettersten K, Baums MH, Meurer A, Lieske S (2014) Analysis of agreement between the German translation of the American Foot and Ankle Society’s Ankle and Hindfoot Scale (AOFAS-AHS) and the foot function index in its validated German translation by Naal et al. (FFI-D). AOTS 134(9):1205–1210. doi:10.1007/s00402-014-2046-0
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Ettinger, S., Stukenborg-Colsman, C., Plaass, C. et al. Tibiocalcaneal arthrodesis as a limb salvage procedure for complex hindfoot deformities. Arch Orthop Trauma Surg 136, 457–462 (2016). https://doi.org/10.1007/s00402-016-2420-1
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DOI: https://doi.org/10.1007/s00402-016-2420-1