Effectiveness of tibio-talo-calcaneal arthrodesis for Charcot ankle arthropathy: Unraveling the impact of glycated hemoglobin on postoperative recovery and complications

Abstract

Abstract Background Charcot arthropathy of the ankle is a severe complication of diabetes that can lead to deformity, ulcers, and amputation. Tibio-talo-calcaneal arthrodesis is a surgical technique to stabilize the ankle, but optimal management remains unclear. Objective This study aimed to evaluate the functional and radiological effectiveness of tibio-talo-calcaneal arthrodesis using retrograde intramedullary nailing without bone graft for Charcot ankle and achieve stable aligned ankle construct. Patients and methods In this prospective study, 31 diabetic patients Eichenholtz stages 2–3 (coalescence or reconstruction phases) Charcot ankle underwent tibio-talo-calcaneal arthrodesis with retrograde nail. The American Orthopedic Foot & Ankle Society ankle-hindfoot score measured outcomes at baseline, 6 months, and 12 months postoperatively. Complications were recorded. Regression analysis identified outcome predictors. Results American Orthopedic Foot & Ankle Society scores improved significantly from 17.4 ± 2.37 preoperatively to 73.4 ± 10.5 at 6 months and 81.9 ± 11.5 at 12 months (P<0.001). Twelve (38.7%) patients experienced complications including deep vein thrombosis and sepsis. Elevated glycated hemoglobin predicted complications (odds ratio=3.25, P=0.010) and longer recovery (B=1.353, P=0.008). An glycated hemoglobin cutoff of 8.0% predicted complications with 75.0% sensitivity and 78.9% specificity (area under the curve=0.816). Conclusion Tibio-talo-calcaneal arthrodesis effectively improved ankle function in Charcot arthropathy but complications were common, emphasizing the importance of perioperative glycemic control.