Percutaneous joint preparation for tibiotalocalcaneal arthrodesis: a case series.

PURPOSE: Tibiotalocalcaneal (TTC) arthrodesis is a limb-salvaging procedure for end-stage ankle and hindfoot pathology but carries substantial risks of nonunion and complications. Minimally invasive approaches may reduce surgical morbidity while maintaining fusion outcomes.

METHODS

This was a retrospective case series of patients who underwent TTC arthrodesis with percutaneous joint preparation between January 2020 and March 2025 at a single academic Level II trauma center. The primary outcome was radiographic or clinical fusion at final follow-up. Secondary outcomes included alignment, operative variables, complications, and functional recovery as measured by Patient Reported Outcomes Measurement Information System (PROMIS) domains.

RESULTS

Thirteen patients (six females) met inclusion criteria with a mean age of 74.0 years and body mass index of 27.1 kg/m2. The mean time from injury to surgery in trauma patients was 6.2 days. Fibular fixation was performed in six cases (46.2%), with additional fixation necessary in select patients. Mean clinical follow-up time was 15.0 ± 4.3 months. Most patients advanced to weightbearing in supportive footwear and reported functional improvement. PROMIS Pain Interference averaged 56.8 ± 10.9, Physical Function 37.7 ± 12.2, and Global Pain 38.7 ± 28.9. Radiographs and computed tomography demonstrated moderate fusion rates in this cohort. Complications included wound issues (23.1%), hardware problems (46.2%), and one tibial shaft fracture after a fall; five patients required secondary screw removal.

CONCLUSION

Percutaneous TTC arthrodesis demonstrated moderate radiographic fusion rates, functional improvement, and an acceptable complication profile for this cohort of predominantly elderly, medically complex patients.