Arthrodesis after failed total ankle replacement

Abstract

We present a series of 16 patients treated between 1993 and 2006 who had a failed total ankle replacement converted to an arthrodesis using bone grafting with internal fixation. We used tricortical autograft from the iliac crest to preserve the height of the ankle, the malleoli and the subtalar joint. A successful arthrodesis was achieved at a mean of three months (1.5 to 4.5) in all patients except one, with rheumatoid arthritis and severe bone loss, who developed a nonunion and required further fixation with an intramedullary nail at one year after surgery, before obtaining satisfactory fusion. The post-operative American Orthopaedic Foot and Ankle Society score improved to a mean of 70 (41 to 87) with good patient satisfaction. From this series and an extensive review of the literature we have found that rates of fusion after failed total ankle replacement in patients with degenerative arthritis are high. We recommend our method of arthrodesis in this group of patients. A higher rate of nonunion is associated with rheumatoid arthritis which should be treated differently.

The Scandinavian Total Ankle Replacement: Survivorship at 5 and 8 Years Comparable to Other Series

“…Fourth, the number of failures in our study was too small to allow statistical exploration of any causal relationships: all but three patients had well-functioning prostheses in situ at a minimum of 5 years. The remaining three underwent successful fusion, which is an effective salvage procedure after failed total ankle arthroplasty [5]. This corresponds to a fusion rate of 6% (3/48), which is comparable to the 5% (29/572) conversion rate to fusion reported in a recent meta-analysis of total ankle arthroplasty [9].…”

Bone tissue engineering: A review in bone biomimetics and drug delivery strategies

“…[4][5][6] Non-unions are also problematic in joint arthroplasties. 7,8 In cases of primary tumor resection or massive traumatic bone loss, bone defects are critical-sized and do not heal with mechanical fixation.…”

“…support and promote osteogenic differentiation in the non-osseous, synthetic scaffold (osteoinduction), 6). enhance cellular activity towards scaffold-host tissue integration (osseointegration), 7). degrade in a controlled manner to facilitate load transfer to developing bone, 8).…”

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.…”