Baumbach SF, Maßen F, Böcker W, Polzer H. [Arthroscopic tibiotalocalcaneal arthrodesis using an intramedullary locking nail].
OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020;
32:158-170. [PMID:
31925449 DOI:
10.1007/s00064-019-00646-7]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE
Arthroscopic tibiotalocalcaneal arthrodesis (TTCA) aims at reconstructing a pain-free, orthograde, and functional limb with reduced invasiveness and lower complication rates compared to open arthrodesis.
INDICATIONS
Combined osteoarthritis of the ankle and subtalar joint or hindfoot malalignment.
CONTRAINDICATIONS
Osteomyelitis/deep soft tissue infections, talus necrosis, severe deformity of hindfoot or distal tibia, pronounced boney defect, indication for combined total ankle replacement and subtalar fusion.
SURGICAL TECHNIQUE
Patient in supine position; arthroscopic debridement of the cartilage and subchondral zone, perforation of the subchondral bone marrow of the ankle and subtalar joint. Foot and hindfoot positioning. Special attention has to be paid to the calcaneus and talus inclination, hindfoot alignment and rotation. Temporary fixation, insertion of the guide wire, reaming and insertion of the retrograde, curved compression arthrodesis nail. If needed, autologous bone grafting. Proximal locking of the nail, application of compression, distal locking, wound closure.
POSTOPERATIVE MANAGEMENT
Lymphatic drainage, physical therapy, and restricted bed rest until wound healing. Non-weightbearing, immobilization for 8 weeks, then step-wise increase of weightbearing. Fitting of custom-made shoes.
RESULTS
Retrospectively included were 15 patients treated by arthroscopic TTCA with an intramedullary nail (average age 56 ± 10 years, 93% male, all had risk factors for postoperative complications). Due to a preoperative plantar ulceration, 4 patients (27%) had 3 ± 1.8 conditioning operations. Sufficient hindfoot correction was achieved in all patients. Major complications occurred in 33% (non-unions). In a subgroup analysis, the presence of a plantar ulceration significantly influenced the development of a major complication. In a case-control study, major complications occurred in 63% and wound complications in 50% of patients for the open technique compared to 33% and 0%, respectively, for the arthroscopic technique. Although the current data do not prove superiority of arthroscopic TTCA compared to open TTCA, there appears to be a strong trend towards considerably lower complication rates following arthroscopic TTCA.
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