Risk Factors and Complications in Tibiotalocalcaneal (TTC) Arthrodesis: A Nationwide Database Comparison Between Traumatic Ankle Fracture and Osteoarthritis

Abstract

Background: Tibiotalocalcaneal (TTC) arthrodesis is an established treatment for osteoarthritis (OA), offering stabilization and earlier weightbearing. However, its role in managing traumatic fractures (TFs) remains controversial because of higher risks of complications. This study aimed to compare complication rates, readmissions, and predictors of adverse outcomes in TTC arthrodesis performed for OA vs TF using a national database. Methods: A retrospective cohort study was conducted using the Nationwide Readmissions Database (2016–2021). Patients undergoing TTC arthrodesis were identified via International Classification of Diseases, Tenth Revision (ICD-10) codes and stratified by indication (OA or TF). Primary outcomes included complication rates, 30- and 90-day readmissions, and revision surgeries. Multivariable logistic regression identified independent predictors of complications. Propensity score matching (PSM) was performed to account for baseline differences. Results: TF cases exhibited significantly higher complication rates (54.5% vs 16.0%, P