The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature.

Tibiotalocalcaneal arthrodesis with an intramedullary nail may find indications for a variety of conditions of the hindfoot. We performed a systematic review of the literature primarily to find out the union rates and complications of tibiotalocalcaneal arthrodesis with an intramedullary nail. We included 33 studies for this review. These studies included 631 patients who had 659 procedures. Eighteen cases were excluded and 641 joints (613 patients) were available for the final analysis. We analysed the indications, union rates, complications and re-operation rates. The union rate was 86.7% with an average union time of 4.5 months. The complication rate was 55.7%. Metalwork related complications made a significant proportion of all the complications. The re-operation rate was 22%. Revision arthrodesis was done in 3% and amputation in 1.5% the cases. The review indicates that tibiotalocalcaneal arthrodesis with an intramedullary nail has a relatively good union rate but a high rate of complications. Majority of the complications are related to the metalwork. The suggested strategies to minimise these complications are discussed.