Use of the Versa nail and anterior ankle arthrotomy to achieve primary tibiotalocalcaneal arthrodesis in rheumatoid arthritis

BackgroundSurgical treatment of rheumatoid ankle can be challenging. Tibiotalocalcaneal arthrodesis is one such treatment and has been performed using various methods and tools including different types of nails.ObjectiveTo evaluate the clinical outcome of primary tibiotalocalcaneal arthrodesis in rheumatoid arthritis using anterior ankle arthrotomy and Versa nail, an intramedullary nail designed specifically for tibiotalocalcaneal arthrodesis.MethodsReview of case records, radiographs and telephonic interview of 11 rheumatoid patients who had undergone primary tibiotalocalcaneal fusion using the Versa nail between March 2004 and May 2005.ResultsArthrodesis was achieved in nine cases. Complications seen in four patients included a non-union, fractured tibia, ulceration and cellulitis. All complications resolved with conservative treatment and none affected the long-term outcome. There was a highly significant improvement in the modified AOFAS score from 18 before surgery to 72 afterwards [p < .0001].ConclusionTibiotalocalcaneal arthrodesis using Versa nail and anterior approach is an effective procedure in rheumatoid arthritis. Anterior approach preserves the malleoli and therefore rotational stability, making it possible to avoid the use of proximal screws. Our study suggests that, in the presence of very osteopenic bone and atrophic skin, it is safe to avoid using screws and to allow weight bearing without compromising the final outcome.