Tibiotalocalcaneal Arthrodesis Using a Supracondylar Femoral Nail for Advanced Tuberculous Arthritis of the Ankle

Abstract

Purpose. To review 7 patients with advanced osteoarticular tuberculous arthritis of the ankle who underwent arthrodesis using a supracondylar femoral nail. Methods. All patients showed gross destruction of the articular cartilage of the tibiotalar joint with severe periarticular rarefaction on radiographs. Their pre- and one-year post-operative Foot and Ankle Outcome Scores (FAOS) were compared. All patients underwent joint debridement, complete synovial excision, and arthrodesis using a supracondylar femoral nail, followed by multidrug chemotherapy for 12 months (isoniazid, rifampicin, pyrazinamide, and ethambutol for 3 months, and isoniazid and rifampicin for 9 months). Results. All patients achieved fusion in a mean of 13 weeks and regained their preoperative level of independence. No patient had a relapse, major complications, or hardware failure. At postoperative year one, the mean FAOS for pain improved to 85 from 26, whereas the mean FAOS for quality of life improved to 60 from 5. Conclusion. Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail, combined with debridement and multidrug therapy, enabled a reliable one-stage solution for advanced osteoarticular tuberculosis and early return to function.

Pseudoelastic intramedullary nailing for tibio–talo–calcaneal arthrodesis

“…The main goal of TTC arthrodesis is to provide a pain-free, functionally stable and realigned fused joint for patients with severe arthrosis. A review for TTC as a salvage procedure showed fusion rates ranging from 76 to 96% (278 out of 319 procedures) [3]; however, more recent studies have shown an average fusion rate of 96.8% (91 fusions of 94 procedures), but have experienced complication rates as high as 25% [4][5][6][7][8][9]. Non-union rates as high as 41% have been reported in studies evaluating more complex pathologies, including Charcot arthropathy, diabetes mellitus, revision and substance abuse [10][11][12], although many of these studies evaluate tibio-talar, tibio-calcaneal and TTC fusions collectively.…”

Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review

“…A total of 83 studies were found through the electronic searching engines, and 10 studies were identified as relevant through manual search. A total of 32 studies [3, 4, 7–10, 12–16, 19, 21–26, 28, 29, 32–34, 38, 40–43, 47–50] were included in this systematic review. Of the included studies, 21 were prospective case series, ten were retrospective case series and one was a RCT.…”

“…Gavaskar et al [22] evaluated seven patients who had undergone TTCA using a shortened supracondylar femoral nail. All the patients were affected by tuberculosis arthritis of the ankle.…”

Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle

“…Pantalar fusion is better obtained by intra-medullary device; when performed during active disease, the procedure should be done under appropriate chemotherapy cover to prevent disease spread or activation. Gavaskar and Chaudhary [27] have used a distal femoral nail in 7 patients of advanced grades of ankle TB arthritis; 5 had severe pain, and 2 could not walk without crutches. Sinuses were present in 3, gross articular destruction was documented in all.…”