Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup and Cone Reamer Technique

End-stage degenerative joint disease of the hindfoot with large structural bone deficits is a complex problem encountered by the foot and ankle surgeon. Surgical treatment of this condition often requires tibiotalocalcaneal fusion with use of structural allograft bone. In this article, we describe a technique in which an acetabular reamer is used to create a concave surface for placement of a convex femoral head allograft. This “cup-and-cone” technique provides a congruent area for placement of the allograft, thereby increasing stability of the graft during preparation and placement of an intramedullary nail, while maximizing bone-to-bone surface contact at the arthrodesis site.