Ankle arthrodesis for failed total ankle replacement

Abstract

Between 1999 and 2005, 23 failed total ankle replacements were converted to arthrodeses. Three surgical techniques were used: tibiotalar arthrodesis with screw fixation, tibiotalocalcaneal arthrodesis with screw fixation, and tibiotalocalcaneal arthrodesis with an intramedullary nail. As experience was gained, the benefits and problems became apparent. Successful bony union was seen in 17 of the 23 ankles. The complication rate was higher in ankles where the loosening had caused extensive destruction of the body of the talus, usually in rheumatoid arthritis. In this situation we recommend tibiotalocalcaneal arthrodesis with an intramedullary nail. This technique can also be used when there is severe arthritic change in the subtalar joint. Arthrodesis of the tibiotalar joint alone using compression screws was generally possible in osteoarthritis because the destruction of the body of the talus was less extensive. Tibiotalocalcaneal arthrodesis fusion with compression screws has not been successful in our experience.

Inferior Results of Salvage Arthrodesis After Failed Ankle Replacement Compared to Primary Arthrodesis

“…2,6,7,10,17,21,24,34,37 While contemporary TAR designs, reveal superior and more reliable overall clinical outcomes and low revision rates, 2,11,13,21,27,36 the long-term results are still not yet predictable and do not match those in total kneeand total hip arthroplasty. 1,3,5,17,19,25,32 With an increasing number of patients undergoing TAR the number of patients who will need a revision operation will rise.…”

“…4,30,38 It sounds logical that-whenever possible-the implant should be salvaged and retained. This can be achieved by adding surgeries (eg, osteotomies, ligament reconstructions) 2,6,7,10,12,21,24,35,37 or simple component exchange. 2,9,11,18,20,21,23,27,29,31,36,39 However, there will always be patients who are not amenable to this kind of treatment and conversion to an arthrodesis can be considered.…”

“…This can be achieved by adding surgeries (eg, osteotomies, ligament reconstructions) 2,6,7,10,12,21,24,35,37 or simple component exchange. 2,9,11,18,20,21,23,27,29,31,36,39 However, there will always be patients who are not amenable to this kind of treatment and conversion to an arthrodesis can be considered.While several studies investigated the radiographic and clinical outcomes after primary ankle arthrodesis, there is a paucity of reports available in the literature that deal with salvage arthrodesis after failed TAR. 2,3,[6][7][8]10,17,21,24,34,37 To the best of our knowledge there has been no comparative analysis performed to assess salvage arthrodesis after failed TAR and primary ankle arthrodesis.…”

“…2,9,11,18,20,21,23,27,29,31,36,39 However, there will always be patients who are not amenable to this kind of treatment and conversion to an arthrodesis can be considered.…”

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

“…The choice of the appropriate surgical approach for hindfoot arthrodesis in this setting can be difficult. Surgery is increasingly difficult and more demanding when performed on a limb that had previous hindfoot surgery, especially previous fusion surgery [3,8,11] or total ankle arthroplasty [10,17,18]. In highrisk patients with tenuous soft tissue envelopes undergoing salvage surgery, a posterior approach can provide a fresh soft tissue plane for surgery and good coverage of hardware [20].…”