Tibiotalocalcaneal (TTC) fusion with a hindfoot nail and femoral head allograft for failed total ankle replacements (TARs)

J.G. Reading, M. Portelli, M.J. Rogers, R.J. Sharp, P.H. Cooke

Introduction: TTC fusion for the salvage of failed TARs with significant bone loss using a hindfoot nail and femoral head allograft has been reported in a number of small series. We present our experience of this procedure.

Method: Review of the theatre records from 2006 to July 2011 identified twenty four cases using this technique. The case notes and imaging were retrospectively reviewed.

Results: Overall eighteen of the twenty four cases had achieved union (mean time 18.8 months). Of this number two had under gone a revision hindfoot nailing and another case needed revision with a circular frame. A further three cases required dynamisation to unite. There were five non unions and one loss to follow up (at two months). Complications included one deep infection (non union) and one case with chronic regional pain syndrome. Metalwork complications included five nail fractures and five cases that required prominent screw removal.

Conclusions: This is the largest series reported using this technique for the salvage of failed TARs with significant bone loss. Other smaller series using this technique have reported union rates around fifty per cent. The time to union is long and half of these cases required further procedures during this course. This is important to reflect when consenting the patient for this type of surgery.