Minimally Invasive Tibiotalocalcaneal Arthrodesis with Blocked Retrograde Intramedullary Nail - Report of Three Cases^*

Abstract

Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective – arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6^th and 10^th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1^st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions – one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.

Keywords
ankle joint; arthrodesis; osteoarthritis; minimally invasive surgical procedures; surgical procedures, operative; ankle