Tibiotalocalcaneal Arthrodesis with Retrograde Intramedullary Nail in Patients with Charcot Neuroarthropathy of the Ankle and Hindfoot
Abstract
Introduction: Tibiotalocalcaneal (TTC) arthrodesis is the treatment of choice for the surgical management of Charcot neuroarthropathy (CN) affecting the ankle. The primary goal is to avoid major amputation and restore a functional lower limb suitable for ambulation, thereby improving patients’ quality of life. Objective: To describe the clinical and radiological characteristics and evolution of patients with diabetes mellitus and Charcot neuroarthropathy who underwent TTC arthrodesis using a straight retrograde intramedullary compression nail. Materials and Methods: This retrospective case series included consecutive patients with CN of the ankle and hindfoot and diabetes mellitus who underwent TTC arthrodesis with a retrograde intramedullary nail. Radiographic union, complications, reoperations, limb salvage, and preoperative metabolic parameters (serum albumin and HbA1c) were evaluated. Results: Eight patients were included, with a median follow-up of 58 months (IQR 40.75–75.5). The median preoperative HbA1c was 6.6% (IQR 5.7–7), and the median serum albumin level was 3.41 g/dL (IQR 3.05–3.71). Three patients required revision surgery. Radiographic union was achieved in seven patients; two developed stable fibrous union, and one patient remains under follow-up.No patient required amputation. Conclusions: TTC arthrodesis with a retrograde intramedullary nail is a viable surgical option fordiabetic patients with Charcot neuroarthropathy involving the ankle. Optimizing preoperative metabolic status and comorbidities, along with appropriate management of osteomyelitis, is essential to reduce complications and promote bone healing.Downloads
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