Tibiotalocalcaneal Arthrodesis: Comparison of Ipsilateral Distal Fibular Autograft as an Intramedullary Strut and Lateral Tibia Plating Versus Intramedullary Nail

BackgroundVarious techniques using different implants with or without bone grafts have been described in tibiotalocalcaneal arthrodesis (TTCA). However, which reconstructive method and fixation device results in better outcomes remains unclear. The purpose of this study was to compare the surgical outcomes of TTCA performed with ipsilateral distal fibular autograft as intramedullary strut and lateral plating (FAISP) or retrograde intramedullary nail (RIMN).MethodsWe retrospectively reviewed the records of patients who underwent TTCA between 2010 and 2021 performed by a single surgeon. The surgery was performed with FAISP prior to January 2017 and with RIMN from January 2017 onward. Outcome assessments included radiographic evaluation, functional evaluation with American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHFS) and visual analogue scale (VAS) for pain, and occurrence of complications.ResultsAmong 30 patients who underwent TTCA, 11 cases were performed with FAISP and 19 cases with RIMN. Mean follow-up was 51.0 and 44.4 months in the FAISP group and the RIMN group, respectively. In the FAISP group, union was successfully achieved in 9 (81.8%) ankle arthrodesis and 7 (63.6%) subtalar arthrodesis. In the RIMN group, union was successfully achieved in 15 (79.0%) ankles arthrodesis and 12 (63.2%) subtalar arthrodesis. No significant difference was found between groups in ankle and subtalar union rate or in time to union. Functional evaluation revealed that mean AOFAS-AHFS score and mean VAS pain score improved significantly after TTCA in both groups, but there was no significant between-group difference in mean AOFAS-AHFS score or mean VAS pain score both preoperatively and at last follow-up. The occurrence of complications was similar between groups.ConclusionsBoth FAISP and RIMN yielded favorable functional and radiographic outcomes for TTCA. FAISP may serve as a viable alternative in select clinical situations.Level of Clinical Evidence:Level III: Retrospective cohort study.