Tibiotalocalcaneal arthrodesis

The purpose of this multicenter retrospective study of 55 patients (56 ankl es) who underwent simultaneous tibiotalocalcaneal arthrodesis with severe d isease involving the ankle and subtalar joints was to determine improvement of pain and function. The surgical indications included osteoarthritis, po sttraumatic injury, failed previous surgery, talar avascular necrosis, oste oarthritis, and rheumatoid arthritis involving the ankle and subtalar joint s. The average age at the time of the operation was 53 years. The average t ime of follow-up was 26 months after the operation. Fusion was achieved in 48 ankles, with an average time of fusion of 19 weeks. Forty-eight of the 5 5 patients were satisfied with the procedure. The average leg length discre pancy was 1.4 cm. The average amount of dorsiflexion was 2 degrees and plan ter flexion was 5 degrees. Following surgery, 42 patients complained of pai n, 40 patients required shoe modification or an orthotic device, and 34 pat ients had a limp. Fourteen patients described their activity as unlimited. Based on the AOFAS evaluation, the patients scored an average of 66 on the ankle-hind foot scale following surgery. The most common complications were nonunion (8 ankles) and wound infection (6 ankles). This study demonstrate s that tibiotalocalcaneal arthrodesis is an effective salvage procedure for patients with disease both involving the ankle and subtalar joints.