Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail for advanced tuberculous arthritis of the ankle.
OBJECTIVE
To review 7 patients with advanced osteoarticular tuberculous arthritis of the ankle who underwent arthrodesis using a supracondylar femoral nail.


METHODS
All patients showed gross destruction of the articular cartilage of the tibiotalar joint with severe periarticular rarefaction on radiographs. Their pre- and one-year post-operative Foot and Ankle Outcome Scores (FAOS) were compared. All patients underwent joint debridement, complete synovial excision, and arthrodesis using a supracondylar femoral nail, followed by multidrug chemotherapy for 12 months (isoniazid, rifampicin, pyrazinamide, and ethambutol for 3 months, and isoniazid and rifampicin for 9 months).


RESULTS
All patients achieved fusion in a mean of 13 weeks and regained their preoperative level of independence. No patient had a relapse, major complications, or hardware failure. At postoperative year one, the mean FAOS for pain improved to 85 from 26, whereas the mean FAOS for quality of life improved to 60 from 5.


CONCLUSIONS
Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail, combined with debridement and multidrug therapy, enabled a reliable one-stage solution for advanced osteoarticular tuberculosis and early return to function.
Gavaskar
Ashok S
AS
Department of Orthopedics, Mahatma Gandhi Medical College, Pondicherry, India. gavaskar.ortho@gmail.com
Chowdary
Naveen
N
D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001174:Arthrodesis / Q000379:methods*; D001182:Arthroscopy; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000382:microbiology; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D013628:Talus / Q000601:surgery; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D014394:Tuberculosis, Osteoarticular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*
D000995:Antitubercular Agents