Abstract
Category:
Ankle; Ankle Arthritis
Introduction/Purpose:
Ankle arthrodesis (AA) is the gold standard for effectively treating end stage ankle arthritis. Anterior anatomic plate fixation has been shown to provide rigid reliable fixation across the fusion site. Tibiotalocalcaneal arthodesis (TTCA) with a retrograde intramedullary nail is an excellent alternative that can be used to address concomitant subtalar arthritis, correct severe hindfoot deformity, and avoid extensive soft tissue dissection. This study evaluates rates of complications and their effect on fusion across the ankle joint in AA with concomitant subtalar arthrodesis in TTCA.
Methods:
This was an IRB-approved retrospective cohort study of patients between 2013-2023 at a single institution who underwent tibiotalar arthrodesis. Patients with longitudinal follow-up were included. Outcomes analyzed in this study included bony union and complications such as revision surgery due to nonunion, irrigation and debridement for infection, removal of symptomatic hardware, and development of postoperative deep venous thrombosis (DVT). T-tests were conducted to determine p-values for the outcome measures and analysis was performed in Microsoft Excel and Python 3.11.7.
Results:
This study included 102 patients who were followed for an average of 1.4 years postoperatively. TTCA was performed using an intramedullary nail in 49 patients; AA was performed with anterior anatomic plate in 53 patients. For patients who underwent TTCA with intramedullary nail, 6% underwent revision surgery for nonunion, 8% underwent I&D for infection, 12% underwent symptomatic hardware removal, and 2% were diagnosed with postoperative DVT. Eleven percent of patients who underwent AA with anterior anatomic plate underwent revision for nonunion, 8% underwent I&D for infection, 9% underwent symptomatic hardware removal, and 0 patients were diagnosed with DVT. There were no significant differences in complication rates between these two groups.
Conclusion:
With the right indication, tibiotalar arthrodesis complication and union rate is comparable in isolated AA and TTCA. Concomitant subtalar joint fusion did not influence ankle joint fusion rate. There were no significant differences in rates of revision surgery due to nonunion, I&D for infection, removal of symptomatic hardware, or postoperative DVT.
