Anterior Plating with Retention of Nail for Salvage Ankle Arthrodesis After Failed Tibiotalocalcaneal Fusion

Abstract

Category: Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal arthrodesis (TTCA) by retrograde intramedullary nailing (RIMN) is commonly used to treat degenerative disease affecting both the tibiotalar and subtalar joints. In the event of TTCA failure, techniques for salvage arthrodesis are not well-described. The aim of this study is to demonstrate the feasibility of anterior plating with retention of nail as a salvage option for patients who experienced failed TTCA by RIMN. Methods: Six patients with failed TTCA following RIMN underwent revision ankle arthrodesis with anterior plating and retention of nail between July 2013 and July 2015. Patient demographics, presentation details, and clinical records were reviewed for clinical and patient-reported outcome measures. Postoperative outcomes consisted of visual analog scale (VAS) pain rating, Coughlin satisfaction scale, Foot & Ankle Activity Measure (FAAM) score, and complications. Results: Anterior plating was performed at a mean of 15.8 months (range, 6.3-25.7) after primary TTCA by RIMN. All patients achieved bony fusion at an average of 9.3 weeks (range, 5.4-16.1) postoperatively. Postoperative outcomes at 1 year follow-up demonstrated an average VAS score improvement from 7.8 to 5.3 (p = 0.019) and an average postoperative FAAM score of 50.9 (range, 37.5-75.0). One major complication occurred in a patient who had a posterior tibial nerve neuroma from the initial TTCA procedure. Despite achieving union following anterior plating, the patient had several subsequent procedures to manage the neuroma but eventually required amputation. There was one minor complication consisting of postoperative swelling requiring a compressive stocking. Conclusion: Anterior plating with retention of nail is a viable option for salvage arthrodesis in patients with failed TTCA after RIMN. Given the complex presentation of most patients with this problem, detailed preoperative counseling regarding the potential risks of surgery should be performed.