Outcomes Following Revision Tibiotalocalcaneal Arthrodesis: A Retrospective Review

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Past research on tibiotalocalcaneal (TTC) arthrodesis has focused on outcomes following primary surgery and reasons for revisions. To our knowledge, no study has reported outcomes following revision TTC arthrodesis. Our study aims to expand the knowledge of revision TTC fusion by analyzing rates of fusion following revision surgery. Methods: The electronic medical record was searched using the current procedural terminology (CPT) codes 27870 and 28725 for TTC and subtalar arthrodesis for three orthopedic surgeons at a single institution between 2011 and 2024. Inclusion criteria included patients over the age of 18 who underwent revision TTC fusion after failure of primary surgery. Patients were excluded for loss to follow-up, lack of post-operative radiographic and clinical outcomes, and a history consisting only of primary TTC fusion. The final patient cohort consisted of 39 patients. Pre-and post-operative radiographs were compared to assess fusion after revision surgery. Radiographic union was defined as greater than 50% of fusion on CT evaluation. Demographics and reasons for revision were collected through chart review. Descriptive statistics were utilized to assess patient demographics, reasons for revision and the frequency of fusion. Results: 51.3% of the patients were male and 48.7% were female. Prior to revision surgery, 62.1% of patients were classified as obese. 30.8% of the patients had a documented history of diabetes, 18.0% with a history of chronic pain, 10.0% with a history of osteoarthritis, and 5.1% with a history of rheumatoid arthritis. The most common reason for revision was nonunion at 84.6% with 10.3% of patients requiring revision for device complications. 53.9% of patients achieved fusion as defined in the methods. Conclusion: Fusion rates for revision TTC arthrodesis are lower than those for the surgery. Patients requiring revision TTC should be counseled on this decreased expected fusion rate prior to consenting to surgery. Future studies should look to incorporate assessment of patient-reported factors including pain and quality of life to further assess success of this procedure.