Tibio-calcaneal fusion by retrograde intramedullary nailing in charcot neuroarthropathy

Abstract

IntroductionCharcot’s neuroarthropathy of ankle leads to instability, destruction of the joint with significant morbidity that may require an amputation. Aim of surgical treatment is to achieve painless stable plantigrade foot through arthrodesis. Achieving surgical arthrodesis in Charcot’s neuroarthropathy has a high failure rate. We assess the outcomes of retrograde intramedullary interlocked nailing in tibio-talar arthrodesis for Charcot’s neuroarthropathy. Materials and Methods42 diabetic patients with a mean age of 49 year underwent ankle tibio-talar arthrodesis using retrograde nailing for Charcot’s neuroarthropathy. The postoperative complications have been discussed and their management outlined. The outcomes were measured radiologically and clinically. Follow up was done after 6 weeks, 3 months, 6 months and 1 year. Results14 patients (33.3%) achieved uneventful uncomplicated fusion. Thirty three patients had varus deformity. Nine patients had valgus deformity. Using Paired t test, it showed statistically significant improvement in the functional outcomes (AOFAS& EQ-5D-5L) over the follow up time, despite of the mild deterioration of radiological angles in the final follow up visit compared to the postoperative radiological findings. ConclusionRetrograde nailing is one of the best options for tibio-talo-calcaneal arthrodesis in the high-risk Charcot’s neuroarthropathy population. It could be done through small incisions with lower soft tissue complications, its load-sharing properties allows a considerable compression across the ankle and talocalcaneal joints with early weight bearing and with satisfactory functional outcomes.