title: Tibiotalocalcaneal fusion using the hindfoot arthrodesis nail: a multicenter study.
abstract: BACKGROUND
  Tibiotalocalcaneal arthrodesis is a salvage option for severe ankle and hindfoot deformities, arthritis of the ankle and subtalar joints, avascular necrosis of the talus, failed total ankle arthroplasty, and Charcot arthropathy. This multicenter study reports clinical experience with the hindfoot arthrodesis nail (HAN) in the treatment of patients with severe ankle and foot abnormalities.
  
  
  METHODS
  Seven participating clinics from Europe and North America recruited 38 patients who underwent ankle/subtalar arthrodesis using retrograde nailing with the HAN. Information was collected regarding technical details, complications, and functional and quality of life outcomes (Short Form-36 [SF-36], American Academy of Orthopaedic Surgeons-Foot and Ankle Outcomes [AAOS-FAO], and numeric rating scale [NRS] for pain) after an average of 2 years of follow-up.
  
  
  RESULTS
  The rate of superficial wound infection was 2.4%. No deep soft tissue or bone infections were reported. The overall union rate was 84%. At the time of follow-up, low pain levels were reported, with a mean NRS of 2.2; the mean AAOS-FAO score was 38; and the SF-36 mean physical and mental health component scores were 41.2 and 52.5, respectively. All 13 patients who were unable to work prior to surgery were able to fully return to work.
  
  
  CONCLUSIONS
  The HAN offered a safe and reliable salvage option for tibiotalocalcaneal arthrodesis in patients with severe ankle and hindfoot disease. It achieved acceptable functional outcome and low complication rates despite the challenging patient cohort. A considerable socioeconomic benefit appeared to result based on the high proportion of patients who were able to return to work postoperatively.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Trauma & Reconstructive Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rammelt
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Pyrc
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Agren
authors.forename: Langdon A
authors.initials: LA
authors.lastname: Hartsock
authors.forename: Patrick
authors.initials: P
authors.lastname: Cronier
authors.forename: David A
authors.initials: DA
authors.lastname: Friscia
authors.forename: Sigvard T
authors.initials: ST
authors.lastname: Hansen
authors.forename: Klaus
authors.initials: K
authors.lastname: Schaser
authors.forename: Jan
authors.initials: J
authors.lastname: Ljungqvist
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Sands
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects; D006801:Humans; D007592:Joint Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D012959:Socioeconomic Factors; D013977:Tibia / Q000601:surgery*
keywords: hindfoot arthrodesis nail; intramedullary fixation; multicenter clinical study; retrograde nailing; tibiotalocalcaneal fusion