Tibiotalocalcaneal fusion using retrograde intramedullary nails as a salvage procedure for failed total ankle prostheses in rheumatoid arthritis A report on sixteen cases

摘要

Between 1996 and 2002, 16 patients with rheumatoid arthritis and failed total ankle prosthesis underwent tibiotalocalcaneal fusion using retrograde intramedullary nails. The functional outcome was evaluated using the AOFAS scoring system and the patients were also asked about their satisfaction. Radiographs were obtained for all 16 cases minimum 1 year after surgery.Thirteen of the 16 ankles were considered radiographically healed, 11 at the first attempt and two after repeat arthrodesis. The median AOFAS pain and total scores were 40 and 58, respectively. Two deep infections resulted in a fused ankle after antibiotic treatment.In patients with rheumatoid arthritis and a failed total ankle prosthesis, tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail resulted in primary healing in two-thirds of the cases. Only two patients with a fused ankle were dissatisfied with the final result. The procedure is recommended in selected cases as an alternative to external fixation.