Reconstructive Arthrodesis for Advanced Ankle and Subtalar Joint Destruction in Neuropathic and Infected Feet

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Limb Salvage

Background:

• Severe hindfoot destruction from neuropathy, infection, or inflammatory conditions poses significant amputation risks.
• Reconstructive surgery offers limb preservation as an alternative to amputation in complex cases.

Purpose of the Study:

• To evaluate the outcomes of reconstructive surgery in patients with severe hindfoot deformities where limb preservation was prioritized.
• To assess the success rates and complications associated with limb-sparing procedures.

Main Methods:

• A retrospective study of 31 reconstructive procedures on 29 patients (2013-2022).
• Etiologies included Charcot arthropathy, osteomyelitis, and rheumatoid deformity.
• Procedures involved various arthrodesis techniques (tibiotalocalcaneal, astragalectomy, tibiotalar) with diverse fixation methods.

Main Results:

• Successful arthrodesis was achieved in 74% of cases.
• Union rates were influenced by fixation type, with external fixation showing the lowest success (17%).
• Complications included surgical site infection (42%) and reoperation (35%); 16% ultimately required amputation.

Conclusions:

• Limb-preserving reconstructive surgery is a feasible option for high-risk patients with severe hindfoot pathology.
• Careful preoperative planning, tailored surgical strategies, and patient compliance are crucial for successful limb salvage.
• Despite high complication rates, this approach can restore weight-bearing capacity and function.