The Impact of Diabetes on Outcomes for Tibiotalocalcaneal Arthrodesis: A Systematic Review of Available Comparative Studies

Background/Objectives: Tibiotalocalcaneal (TTC) arthrodesis is commonly used in salvage situations involving the ankle and subtalar joint, often in patients with concomitant diabetes mellitus (DM). Across orthopedics, DM presents an overall increased risk of developing complications post-surgically. In this systematic review, the primary aim was to summarize the outcomes and complications of patients undergoing TTC arthrodesis with DM. Methods: A qualitative systematic review was conducted, with an initial search performed on 30 August 2023, using PubMed, SPORTDiscus, CINAHL, and MEDLINE. The search algorithm “tibiotalocalcaneal” AND (nail OR nails) AND (fusion OR arthrodesis) was applied, following PRISMA guidelines. Inclusion criteria encompassed articles examining the impact of diabetes on TTC arthrodesis outcomes. Data extraction involved patient demographics, complication rates, and surgical outcomes. Due to data heterogeneity, a narrative approach was utilized to describe results across studies. Results: Four articles met the inclusion criteria. These observational comparative studies were of moderate quality, with a mean MINORS score of 20.5 ± 1.9 points. The combined patient cohort included 162 patients, evenly split between diabetic and non-diabetic groups, with a mean age of 58.2 ± 2.7 years and a follow-up duration of 35.0 ± 7.4 months. Diabetic patients exhibited higher rates of superficial infection, though functional outcomes and fusion rates were generally favorable. Conclusions: TTC arthrodesis in diabetic patients was associated with an increased risk of superficial infections and various other complications. Despite these risks, functional outcomes and rates of successful fusion were comparable to non-diabetic patients undergoing TTC arthrodesis. This review highlights the need for standardized definitions of surgical success.