Simultaneous septic arthrodesis of the tibiotalar and subtalar joints with the Ilizarov external fixator—an analysis of 13 patients

Purpose Treatment of joint destruction of the tibiotalar and subtalar joints caused by acute or chronic infections in compromised hosts is a challenging problem. In these cases, simultaneous septic arthrodesis with the use of the Ilizarov external fixator represents a possible alternative to amputation. This case series presents the results and complications of patients with acute or chronic infection of the tibiotalar and subtalar joints. Methods Between 2005 and 2015, 13 patients with acute or chronic infections were treated by simultaneous single-stage debridement/arthrodesis of the tibiotalar and subtalar joints. In seven patients, there was a florid infection with fistula formation and soft tissue defects, and in six patients, there was chronic osteomyelitis with closed soft tissue. In addition to the demographic data, the time spent in the fixator, the major and minor complications and the endpoint of consolidation were reviewed. Results The mean time spent in the fixator was 18 (min 15, max 26) weeks. The mean follow-up time for nine patients was 100 (min 3, max 341) weeks. Complete osseous consolidation of both the tibiotalar and subtalar joints was achieved in 10 patients (77%). In three (23%) patients, there was complete consolidation of one of the joints and partial consolidation of the other joint. Conclusion The Ilizarov external fixator allows for simultaneous arthrodesis of the tibiotalar and subtalar joints in septic joint destruction. However, the healing rates are below the rates reported in the literature for isolated tibiotalar or tibiocalcaneal arthrodesis in comparable clinical situations.

Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients

Introduction Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure. Materials and methods Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score. Results The average time spent in the fixator was 22 (range 14–34) weeks. The average follow-up in 17 patients was 116 (range 4–542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points. Conclusion Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.

Outcomes of Tibiocalcaneal Arthrodesis in High Risk Patients: An Institutional Cohort of 18 Patients

Category: Hindfoot Introduction/Purpose: Tibiocalcaneal (TC) arthrodesis is commonly performed in patients with severe hindfoot disease. These include severe Charcot deformities, ankle malformations, chronic osteomyelitis (COM), and avascular necrosis (AVN). The talar vasculature becomes disrupted to the point that the bone can no longer be salvaged. The procedure involves performing a talectomy and fusing the tibia to the calcaneus. This helps in preserving the remaining hindfoot anatomy while allowing the patient to regain function and mobility. Our study highlights certain risk factors that influence the rate of postoperative complication after tibiocalcaneal surgery. Methods: We retrospectively reviewed the charts of 18 patients from a single institution who underwent tibiocalcaneal arthrodesis between the years of 2011 and 2019. Preoperative diagnoses, comorbidities, post-operative outcomes were noted among all patients. Then, the rates of non-union, below-knee amputations, revision surgeries, postoperative infections, and hardware failure were recorded. This data was then analyzed to determine which preoperative and perioperative factors affected postoperative outcomes for patients after tibiocalcaneal arthrodesis surgery. Results: Nonunion was the most commonly reported complication in this series. Eight of the eighteen patients were documented to have nonunion including three patients with stable pseudarthrosis. Diabetic patients had a slightly higher incidence of nonunion (4 of 7 patients) compared to those without diabetes (4 of 11 patients). Of the 9 patients diagnosed with Charcot arthropathy, 5 had nonunion. Three of five individuals with a BMI ranging from 25-30, and four of six individuals with a BMI of greater than 30 had a nonunion. Infection was a post-operative complication for four of the eighteen patients. Two of the four patients had multiple comorbidities in addition to chronic infections in the joint which were recurrent after surgery. Conclusion: In conclusion, TC arthrodesis provides a viable option for high risk patients with complicated ankle pathology who have not had successful outcomes from previous treatment. It is not without complications considering the comorbidities the patients present with before requiring this procedure. Further studies are necessary in order to validate the trends of outcomes and comorbidities of patients with TC arthrodesis. [Table: see text]

Tibiocalcaneal arthrodesis in fixed equinus deformity with ring fixator

Objective: To evaluate the limb function and quality of life of patients with posttraumatic fixed equinus deformity treated at a tertiary hospital after arthrodesis with the Ilizarov external fixator. Methods: A study was conducted from January 2015 to June 2018 in which 6 patients were evaluated at outpatient follow-up in the late postoperative period. First, an identification questionnaire was administered to assess limb function using the American Orthopedic Foot and Ankle Society (AOFAS) scale, and quality of life was assessed using the SF-36 questionnaire. Results: A total of 66.6% of the sample had an AOFAS score below 70 (mean total = 57.5), which is considered poor. The mean SF-36 score was low (below 60) in all domains evaluated. The pain domain had the highest score (mean = 57.2). Conclusions: Even after surgery to correct the deformity, patients had impaired function and quality of life. Level of Evidence IV; Therapeutic Studies; Case Series.

Tibiocalcameal arthrodesis as a surgical option for Charcot ankle deformity

Object. To assess the effectivity and safety of different tibiocalcaneal arthrodesis types in treatment of patients with Charcot ankle deformity depending on disease severity. Materials and methods. We have analyzed the outcomes after treatment of 16 patients with diabetic neuropathic ankle arthropathy (Charcot ankle) at the stage of septic complications in bones of ankle and subtalar joints. The observation period was more than 1 [1–3] year. Ilizarov fixator for TCA was used in 8 cases; internal fixation with cannulated screws was applied in 8 cases.Results. In the early periods (up to 1 month from the operation) no complications were revealed. Complications in later terms developed in 4 patients: three with internal fixation and one with external.Conclusion. In our opinion, when choosing foot fixation tactics for heel-tibial arthrodesis, risk groups should be considered stage D according to Rogers classification and stage 3 according to Wagner classification, and after resection of bones in these patients external fixation is preferable. In the remaining stages, internal fixation is advisable because of the patient's higher quality of life and shortening of the rehabilitation period.

Salvage surgery for Charcot arthropathy of the diabetic hindfoot

Objective: This study evaluated the effectiveness of Charcot arthropathy (CA) surgery to align and stabilise the severely deformed hindfeet of patients with diabetes so that the affected limb would be able to support patients’ body weights and restore walking independence. Methods: A total of 25 patients with cases of CA compromising the ankle (type IIIA) or hindfoot (type IV) underwent a procedure to salvage their affected limbs via tibiocalcaneal arthrodesis fixed with an interlocking intramedullary nail. The mean follow-up period was 49 (6–169) months, and the mean age of patients was 54 (30–83) years. The outcome was considered as satisfactory in cases where the patients were able to walk independently and maintain their repaired foot on the ground; the outcome was considered as unsatisfactory when the affected limb presented with frank instability or deformity. Results: The outcomes were satisfactory in 19 of the 25 (76%) repaired limbs, although 11 of the 25 (44%) limbs presented with complications. Conclusions: The salvage of a severely deformed and markedly unstable limb due to CA complications involving the ankle (type IIIA) or hindfoot (type IV) should be considered for patients with diabetes because the prognosis is favourable in cases where the affected limb is surgically treated using tibiocalcaneal arthrodesis and an interlocking intramedullary nail. Level of Evidence IV; Therapeutic Studies; Case Series.