Hindfoot arthrodesis with a trabecular metal ankle fusion spacer and retrograde nail in charcot arthropathy of the ankle: A case report

Abstract

We report our use of trabecular metal ankle fusion spacers to treat diabetic Charcot ankle. A 61-year-old man with type 2 diabetes (10 years duration) presented at a local clinic with left ankle swelling and warmth. Infection was suspected, but antibiotic treatment produced no improvement; thus, two operations were performed. Joint destruction progressed until the patient was referred to our institution. During our initial examination, inflammation was evident, with talus and anterior tibial plafond collapse. Arthroscopic synovectomy and continuous irrigation were performed to exclude infection. Pathological investigations showed no signs of infection. Diabetic Charcot neuroarthropathy was diagnosed, and surgery was performed 1 month later. A large bone defect in the talar body made talocrural arthrodesis unfeasible; tibiocalcaneal arthrodesis, employing a retrograde intramedullary nail and trabecular metal ankle spacers, was selected instead. Postoperative splint immobilization was employed, and no weightbearing was permitted for the first few weeks. Nine months postoperatively, synostosis was achieved, and the patient could walk independently with a brace. As the patient had a considerable bone defect, we performed ankle joint fusion using trabecular metal ankle fusion spacers, which are produced in various sizes and can be positioned to fill the gap created by the bone defect. In this situation, we chose a strong trabecular metal ankle spacer that could also accommodate an intramedullary nail. Thus, tibiocalcaneal arthrodesis using a retrograde intramedullary nail and trabecular metal ankle fusion spacers was stable. The patient's Charcot ankle achieved fusion.

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