Arthroscopic versus open hindfoot fusion using a retrograde tibiotalocalcaneal nail

Tibiotalocalcaneal (TTC) fusions are often performed as a salvage procedure in patients with severe hindfoot arthritis or hindfoot deformity. Comorbidities in this patient cohort are frequent, leading to increased risk of postoperative complications. Arthroscopic debridement may afford better wound healing and possible improvement of blood supply. This study compares the outcome of a challenging set of patients undergoing TTC fusion with either arthroscopic or open technique.

For this cohort study, the data for patients undergoing TTC fusion from 2009 to 2018 was prospectively collected and the study design is retrospective. 58 consecutive cases were identified; in 51 cases a TTC fusion was performed while in 7 cases a tibiotalar fusion was performed in the setting of a preexisting talocalcaneal fusion. Arthroscopic technique was used in 22 fusions and open technique in 36 fusions.

An overall union rate of 89.7% was achieved. Five tibiotalar non-unions and one non-union of both the tibiotalar and talocalcaneal joints was documented. In the arthroscopic fusion group the non-union rate was 9.1% while in the open group it was 11.1%. The overall reoperation rate was 17%. No patient in the arthroscopic fusion group required a reoperation, whereas in the open group the reoperation rate was 27.8%. In patients with PROs the AOS score improved from 53.1 to 26.2 for the arthroscopic group and from 57.2 to 32.3 for the open group. The satisfaction score improved from 1.4 to 2.7 in the arthroscopic group, and 1.1 to 2.8 in the open group.

Arthroscopic TTC fusions are a viable alternative to the open procedure. Nonunion rates are similar, while wound complication rates and reoperation rates are lower. Outcomes measured by PROs are comparable.

Level IV, case cohort study.