Percutaneous joint preparation for tibiotalocalcaneal arthrodesis: a case series

Tibiotalocalcaneal (TTC) arthrodesis is a limb-salvaging procedure for end-stage ankle and hindfoot pathology but carries substantial risks of nonunion and complications. Minimally invasive approaches may reduce surgical morbidity while maintaining fusion outcomes.

This was a retrospective case series of patients who underwent TTC arthrodesis with percutaneous joint preparation between January 2020 and March 2025 at a single academic Level II trauma center. The primary outcome was radiographic or clinical fusion at final follow-up. Secondary outcomes included alignment, operative variables, complications, and functional recovery as measured by Patient Reported Outcomes Measurement Information System (PROMIS) domains.

Thirteen patients (six females) met inclusion criteria with a mean age of 74.0 years and body mass index of 27.1 kg/m². The mean time from injury to surgery in trauma patients was 6.2 days. Fibular fixation was performed in six cases (46.2%), with additional fixation necessary in select patients. Mean clinical follow-up time was 15.0 ± 4.3 months. Most patients advanced to weightbearing in supportive footwear and reported functional improvement. PROMIS Pain Interference averaged 56.8 ± 10.9, Physical Function 37.7 ± 12.2, and Global Pain 38.7 ± 28.9. Radiographs and computed tomography demonstrated moderate fusion rates in this cohort. Complications included wound issues (23.1%), hardware problems (46.2%), and one tibial shaft fracture after a fall; five patients required secondary screw removal.

Percutaneous TTC arthrodesis demonstrated moderate radiographic fusion rates, functional improvement, and an acceptable complication profile for this cohort of predominantly elderly, medically complex patients.