A Retrospective Comparative Study of Arthroscopic Versus Open Tibiotalocalcaneal Arthrodesis Using a Straight Retrograde Intramedullary Nail.

BACKGROUND

Tibiotalocalcaneal arthrodesis (TTCA) using a straight retrograde intramedullary nail (RIMN) is an established salvage procedure for severe ankle and hindfoot pathology. Direct comparative evidence between open and arthroscopic TTCA remains limited.

PURPOSE: To compare clinical, radiographic, and perioperative outcomes between open and arthroscopic TTCA performed using a straight RIMN.

STUDY

DESIGN

Retrospective comparative study.

PATIENTS AND

METHODS

Fifty-five patients (55 feet) who underwent TTCA between December 2022 and December 2024 were retrospectively reviewed, including 28 treated with open TTCA and 27 with arthroscopic TTCA. No patient underwent bilateral procedures during the study period. Outcomes included operative duration, intraoperative blood loss, length of hospital stay, clinical scores, complications, and CT-confirmed fusion. Solid fusion was defined as ≥75% osseous bridging across the arthrodesis interface on CT.

RESULTS

CT-confirmed fusion was observed in 27 of 28 patients in the open group (96.4%; 95% CI, 82.3%-99.4%) and 26 of 27 patients in the arthroscopic group (96.3%; 95% CI, 81.7%-99.3%; p = 0.987). Time to fusion and operative duration did not differ significantly between groups (p = 0.421 and p = 0.308, respectively). Arthroscopic TTCA was associated with lower intraoperative blood loss (p < 0.0001) and shorter hospital stay (p = 0.021). AOFAS, Pain-NRS, SF-36, and UCLA scores improved significantly from baseline in both groups. Two superficial wound infections occurred in the open group; one resolved with conservative treatment and one required surgical debridement.

CONCLUSION

Arthroscopic TTCA with RIMN showed similar observed fusion rates and functional outcomes to the open approach and was associated with lower intraoperative blood loss and shorter hospitalization. Given the retrospective design and temporal imbalance between the groups, these findings should be interpreted cautiously. Arthroscopic TTCA may represent a feasible alternative in selected patients.

LEVEL OF EVIDENCE: Level III.