Mid- and Long-Term Outcomes of Tibiotalar, Triple, and Tibiotalocalcaneal Arthrodesis for Advanced Ankle Osteoarthritis

Aim: To compare mid- to long-term outcomes of tibiotalar arthrodesis (TTA), triple arthrodesis (TA), and tibiotalocalcaneal arthrodesis (TTCA). Outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS), complications, revision, and adjacent joint osteoarthritis.Material and Methods: This retrospective study included 32 patients who underwent arthrodesis between 2015 and 2024: TTA with cannulated screws (n=15), TA with cannulated screws and staples (n=8), or TTCA with a retrograde intramedullary nail (n=9). Follow-up duration was 4.0 (2.75–7.0) [1–10] years. Functional outcomes were assessed using the AOFAS ankle-hindfoot score and VAS. Complications, revision surgery, and adjacent joint osteoarthritis were also evaluated.Results: AOFAS scores were comparable among groups (p=0.542), whereas VAS scores differed significantly (p=0.037). Post hoc comparisons showed lower VAS scores after TTCA than after TA (adjusted p=0.036); TTA did not differ from TA (p=0.305) or TTCA (p=0.135). Postoperative complications occurred in three TTA patients (20.0%), no TA patients, and one TTCA patient (11.1%), without a group difference (p=0.670). One TTA patient underwent revision for nonunion; revision rates were comparable (p=1.000). Adjacent joint osteoarthritis occurred in one patient.Conclusion: The procedures provided comparable AOFAS scores and low complication and revision rates. TTCA was associated with lower pain than TA, but this finding requires caution given the retrospective design, small groups, and differing indications. Procedure selection should reflect joint involvement, deformity, bone quality, and patient characteristics.