title: Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle.
abstract: BACKGROUND
  Tibiotalocalcaneal arthrodesis in patients with large segmental bony defects presents a substantial challenge to successful reconstruction. These defects typically occur following failed total ankle replacement, avascular necrosis of the talus, trauma, osteomyelitis, Charcot, or failed reconstructive surgery. This study examined the outcomes of tibiotalocalcaneal (TTC) arthrodesis using bulk femoral head allograft to fill this defect.
  
  
  METHODS
  Thirty-two patients underwent TTC arthrodesis with bulk femoral head allograft. Patients who demonstrated radiographic union were contacted for SF-12 clinical scoring and repeat radiographs. Patients with asymptomatic nonunions were also contacted for SF-12 scoring alone. Preoperative, intraoperative, and postoperative factors were analyzed to determine positive predictors for successful fusion.
  
  
  RESULTS
  Sixteen patients healed their fusion (50% fusion rate). Diabetes mellitus was found to be the only predictive factor of outcome; all 9 patients with diabetes developed a nonunion. In this series, 19% of the patients went on to require a below-knee amputation.
  
  
  CONCLUSIONS
  Although the radiographic fusion rate was low, when the 7 patients who had an asymptomatic nonunion were combined with the radiographic union group, the overall rate of functional limb salvage rose to 71%. TTC arthrodesis using femoral head allograft should be considered a salvage procedure that is technically difficult and carries a high risk for complications. Patients with diabetes mellitus are at an especially high risk for nonunion.
  
  
  METHODS
  Level IV, retrospective case series.
authors: Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA.
authors: Clifford L
authors: CL
authors: Jeng
authors: John T
authors: JT
authors: Campbell
authors: Edward Y
authors: EY
authors: Tang
authors: Rebecca A
authors: RA
authors: Cerrato
authors: Mark S
authors: MS
authors: Myerson
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D002111:Calcaneus / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004599:Electric Stimulation Therapy; D005260:Female; D005270:Femur Head / Q000637:transplantation*; D005599:Fractures, Ununited / Q000453:epidemiology; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D013628:Talus / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D014184:Transplantation, Homologous
keywords: allograft; ankle; arthritis; arthrodesis; diabetes; tibiotalocalcaneal fusion