Tibiotalocalcaneal Arthrodesis: Deformity Correction in Medically Comorbid Patients.

BACKGROUND

Tibiotalocalcaneal (TTC) arthrodesis is a common orthopaedic procedure used to manage end-stage pathologies of the ankle and hindfoot. A variety of surgical techniques exist to accomplish TTC arthrodesis. We retrospectively reviewed and compared postoperative outcomes of 2 different TTC arthrodesis constructs, including intramedullary nail (IMN) and open plating (OP) with a plate/screw construct, in high-risk patients with a wide range of deformity and comorbidities.

METHODS

A retrospective review was conducted on 73 ankles of 69 consecutive patients who underwent TTC arthrodesis by a fellowship-trained foot and ankle orthopaedic surgeon at a tertiary referral academic center between 2014 and 2025. Diagnoses, patient characteristics and comorbidities, postoperative outcomes, and operative data were recorded and evaluated.

RESULTS

Postoperative complications occurred in 23 of 73 ankles overall (32%), including 16 of 55 IMN fusions (29%) and 7 of 18 OP fusions (39%) (OR 0.64, 95% CI 0.21-1.96; P = .56). Revision TTC arthrodesis was required after 2 of 55 IMN TTC fusions (4%) and 5 of 18 OP TTC fusions (28%) (OR 0.10, 95% CI 0.02-0.56; P = .008). IMN revisions were for 2 periprosthetic fractures. OP revisions were for 4 nonunions and 1 periprosthetic fracture. Amputation was performed after 4 IMN fusions (7%) and 1 OP fusion (6%)(OR 1.33, 95% CI 0.14-12.76; P = .99). In 19 ankles that presented with nonunion, the salvage TTC arthrodesis was associated with 2 revision TTC fusions (11%), 1 persistent nonunion (5%), and 1 amputation (5%). In 34 ankles that presented with Charcot arthropathy, the salvage TTC arthrodesis was associated with 4 amputations (12%), 2 nonunions (6%), 2 periprosthetic fractures (6%), and 2 revision TTC fusions (6%). Hardware removal was necessary after 13 surgeries (18%).

CONCLUSION

This study suggested a lower rate of union and an increased rate of revision surgery after open plating arthrodesis compared with intramedullary nail arthrodesis. Overall, intramedullary nailing may be a more reliable construct compared with open plating in high-risk patients with diabetes and severe deformities.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.