Tibiotalocalcaneal arthrodesis for end‑stage post‑traumatic osteoarthritis of the ankle and subtalar joints: a comparative assessment of internal fixation implants

Introduction Post-traumatic osteoarthritis of the ankle and subtalar joints develops secondary to joint trauma, with clinical signs of pain and dysfunction of the lower limbs in working age patients. Tibiotalocalcaneal arthrodesis (TTCA) is the standard surgical treatment for end-stage disease. The optimal fixation method remains a matter of debate.

The objective was to compare clinical and functional outcomes of TTCA for end-stage post-traumatic osteoarthritis of the ankle and subtalar joints using three methods of internal fixation.

Material and methods A retrospective controlled parallel-group study enrolled 46 patients treated with TTCA and anatomically curved retrograde intramedullary nail (Group 1, n = 15); TTCA using a straight retrograde intramedullary nail (Group 2, n = 15); arthrodesis and interlocking nailing (Group 3, n = 16). Clinical status and functionality were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Scale (VAS). Statistical analysis was produced using Kruskal – Wallis test, Mann – Whitney U-test with Bonferroni correction, Pearson χ² test, Fisher's exact test (p < 0.05).

Results Groups were comparable for age and VAS pain intensity at baseline (p = 0.162 and p = 0.268, respectively). Baseline AOFAS differed significantly (p = 0.049) with the median measuring 20.0 (15.0–32.5) in Group 1, 32.0 (27.5–40.0) in Group 2, and 29.5 (26.0–37.2) in Group 3. The AOFAS functional scores were comparable at a follow-up examination measuring 73.0 (52.5–79.0), 71.0 (66.5–78.0), and 75.0 (50.8–80.0) in the groups, respectively (p = 0.978). Pain reduction was equivalent across groups (p = 0.661). Complications developed in seven cases (15.2 %) with no significant between groups differences (p = 0.354); active smoking was a significant predictor of complications (31.2 % vs 6.7 %; p = 0.040). Patient satisfaction was 100%, 93.3 %, and 75.0% in groups 1, 2 and 3, respectively (p = 0.067).

Discussion Comparable outcomes across three groups were consistent with the literature: the success of arthrodesis rather relies on adequate foot positioning and the quality of joint resection rather than on a fixation construct.

Conclusion The three internal fixation options for TTCA provided comparable clinical and functional results in the mid-term follow-up period. Individual patient characteristics and surgical experience would be essential for the choice of the construct.

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