Abstract
BackgroundTibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. We hypothesized that these screws could be suitable for tibiotalocalcaneal arthrodesis because of their special design. This study aimed to evaluate the clinical outcomes of patients undergoing tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint.MethodsFrom 2010 to 2015, 23 patients with severe ankle and subtalar arthropathy underwent tibiotalocalcaneal arthrodesis. All surgeries were completed by a senior surgeon in the same hospital. These patients were 18~76 years (mean 54.6 years) old; the duration of their disease was 9~38 months (mean 13.2 months). The study population included 12 males and 11 females; 12 patients underwent surgery on the left and 11 on the right. Indications for surgery included avascular necrosis of the talus (n = 14), severe posttraumatic arthritis (n = 4), osteoarthritis (n = 2), terminal tuberculous arthritis (n = 1), rheumatoid arthritis (n = 1) and Charcot neuroarthropathy (n = 1). A lateral oblique incision was performed to expose the subtalar joint, and an anteromedial longitudinal incision was used to expose the ankle joint. After the articular surfaces were removed, the tibia, talus and calcaneus were carefully aligned and fixed with two headless compression screws. Patients were followed up at 6 weeks and 3, 6 and 9 months after surgery; they were evaluated by Roles and Maudsley patient satisfaction scores, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) score and radiographic evaluation.ResultsSeventeen patients were studied, with a mean follow-up time of 6.5 months (range 5–24). The mean Roles and Maudsley patient satisfaction score was 1.41 at the last follow-up; most of the patients were satisfied with the surgery results. The mean preoperative AOFAS Ankle-Hindfoot Score was 29.6 (range 18–37), while the mean last follow-up AOFAS Ankle-Hindfoot Score was 68.5 (range 61–80). The VAS score for preoperative functional pain was 6.95 (range 3–10) compared to 1.56 (range 0–3) postoperatively (P < 0.001). The mean surgical duration was 57 (range 42–125) min. The mean time to union was 3.8 months (range 3–12 months); fusion of the ankle and subtalar joint was successful in all patients. One patient experienced delayed wound healing.ConclusionsTibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint is an effective treatment that is minimally invasive and is associated with a short operation time, high fusion rate, low incidence of complications and good postoperative recovery.
Highlights
Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported
Severe ankle and subtalar arthritis is the end stage of articular cartilage damage and malformation caused by many factors, such as trauma, failure of ankle arthrodesis, talar ischaemia and necrosis, adult-acquired flat foot, severe osteoarthritis, severe rheumatoid arthritis, infection, failure of ankle replacement, severe talipes equinovarus deformity, other congenital deformities, Charcot’s disease and neuromuscular disease
The overriding indication for tibiotalocalcaneal arthrodesis is ankle and subtalar arthritis caused by severe osteoarthritis, talar ischaemia and necrosis, or failure of ankle replacement
Summary
Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. Tibiotalocalcaneal arthrodesis is a surgical procedure that aims to alleviate pain, restore the walking gait and improve the patient’s quality of life Fusion of both the ankle and subtalar joints is performed at the same time to maintain the stability of the hindfoot and to correct the hindfoot alignment [3, 4]. More surgeons prefer using the intramedullary nail, which can provide good structural stability, axial compression and anti-rotation properties [3, 11] This fixation method has a high degree of technical difficulty in inserting the nail and a relatively high rate of complications such as neurovascular injury, soft tissue irritation, deep infection and bone fracture surrounding the end of the nail in the distal tibia [3, 12]. A simple tibiotalocalcaneal arthrodesis fixation method with a high union rate and low complication rate has not yet been reported
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