Functional and Radiological Outcomes of Tibio-TaloCalcaneal Arthrodesis Using Retrograde Intramedullary Nailing: An Ambispective Cohort Study from a Tertiary Orthopaedic Centre in South India

Abstract

Background
Tibio-talo-calcaneal (TTC) arthrodesis using retrograde intramedullary nailing is a widely accepted salvage procedure for complex hind-foot pathology. Despite its increasing utilization, functional outcomes from Indian settings using validated patient-reported outcome measures (PROMs) remain under-reported. This study evaluates radiological union, pain relief, and PROM trajectories following TTC fusion with retrograde nailing.
Methods
An ambispective observational cohort was conducted at a tertiary orthopaedic center between September 2023 and April 2025. Adults (≥18 years) with post-traumatic or degenerative hind-foot arthritis, talar avascular necrosis, or paralytic deformity undergoing TTC arthrodesis with a retrograde nail were included. Patients with uncontrolled diabetes or active peripheral vascular disease were excluded. Thirty patients (mean age: 51.2 ± 10.2 years; 60% male) were analyzed. Functional outcomes were assessed preoperatively and at 1, 6, and 12 months using the Foot and Ankle Outcome Score (FAOS), Foot Function Index (FFI), and Numeric Pain Scale (NPS). Fusion status, time to weight-bearing, and complications were recorded prospectively. Statistical significance was set at p < 0.05.
Results
At 12 months, mean FAOS improved from 30.66 to 88.31, FFI decreased from 181.11 to 118.40, and NPS declined from 7.10 to 1.47 (all p < 0.001). Radiological fusion was achieved in 96.7% at a mean of 14.5 weeks. Full weight-bearing commenced at 16.1 weeks, with functional independence by 6.8 months. Overall complication rate was 26.7%, primarily delayed wound healing (13.3%).
Conclusion
TTC arthrodesis with retrograde intramedullary nailing offers reliable fusion, significant pain reduction, and improved function in complex hind-foot pathology with acceptable complication rates.