Arthrodesis of the hind-foot using a retrograde Kuntscher nail in rheumatoid arthritis

Purpose of the study Many techniques for ankle arthrodesis have been described. Some are not app licable to patients with severe rheumatoid arthritis (RA) because of osteop enia and deformities. This study describes a new surgical technique for art hrodesis in painful valgus deformity of the hind-foot in advanced rheumatoi d arthritis (RA) with severe osteopenia. Materials The present series included 9 patients. Eleven talocrural and talocalcaneal arthrodeses were performed for degenerative changes secondary to RA involv ing hind-foot joints, All patients were reviewed after an average follow-up of 6 years. Mean duration of RA was 34 years. All patients had severe oste openia, including major deformations of the hind-foot in 5 cases. Methods After removal of talocrural and talocalcaneal articular surfaces using an a nterolateral approach, deformities were corrected by removal of an appropri ate bone wedge, A Kuntscher nail was then positioned in the calcaneal plant ar cortical through the plantar surface of the foot and driven proximally i nto the medullary canal of the tibia through the talus. This nail allowed b oth deformity correction and fixation, Aftercare required immobilization in a short leg cast. Weight bearing was allowed with the cast approximately 5 weeks after surgery. The ankle was immobilized for 7.5 weeks. Discussion Results showed a 80 per cent fusion rate. Two non-unions occurred (one recu rrence of valgus deformity after early nail migration requiring removal of the nail; and the other asymptomatic). A complication occurred in one foot (delayed healing), At follow-up, all patients but one were satisfied with r espect to pain relief and residual deformities. Our results are comparable with those of other series and should be considered in the context of sever e RA. Conclusion This technique of vertical retrograde transarticular nailing allows an easy control of hind-foot deformities correction, Other techniques are preferab le in case of solid bone, This technique is an acceptable alternative in ad vanced RA.