title: Tibio-talocalcaneal arthrodesis as a primary procedure using a retrograde intramedullary nail: a retrospective study of 26 patients with rheumatoid arthritis.
abstract: BACKGROUND
  Arthrodesis of the ankle joint using screws or external fixation is often a demanding procedure, notably in patients with rheumatoid arthritis. We investigated whether tibio-talocalcaneal arthrodesis with the use of an intramedullary nail is a safe and simple procedure.
  
  
  METHODS
  We retrospectively reviewed 25 ankles (25 patients) at median 3 (1-7) years after tibio-talocalcaneal arthrodesis because of rheumatoid arthritis. All had been operated on by retrograde insertion of a retrograde nail. 5 types of nail had been used. Complications, functional outcome scores, and patient satisfaction were determined and the radiographs evaluated for healing.
  
  
  RESULTS
  All but 1 ankle had a radiographically healed arthrodesis. We recorded 3 deep infections, all healed--in 2 cases after extraction of the nail--and the arthrodesis healed in all 3 patients. The average functional scores at follow-up were high, considering that the patients suffered from rheumatoid arthritis. 23 patients were satisfied with the outcome. We found a correlation between the functional scores and the general activity of the disease expressed as a Health Assessment Questionnaire score.
  
  
  CONCLUSIONS
  In patients with rheumatoid arthritis, tibio-talocalcaneal arthrodesis with a retrograde intra-medullary nail results in a high rate of healing, a high rate of patient satisfaction, and relatively few complications.
authors.affiliation: Department of Orthopaedics, Malmö University Hospital, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Anderson
authors.forename: Lars
authors.initials: L
authors.lastname: Linder
authors.forename: Urban
authors.initials: U
authors.lastname: Rydholm
authors.forename: Fredrik
authors.initials: F
authors.lastname: Montgomery
authors.forename: Jack
authors.initials: J
authors.lastname: Besjakov
authors.forename: Ake
authors.initials: A
authors.lastname: Carlsson
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis; D011859:Radiography; D012189:Retrospective Studies; D013628:Talus / Q000601:surgery; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing