Outcomes of revision surgery for failed total ankle replacement: revision arthroplasty versus arthrodesis

Egglestone, Anthony; Kakwani, Rajesh; Aradhyula, Murty; Kingman, Angela; Townshend, David

doi:10.1007/s00264-020-04784-7

Cited by 22 publications

(22 citation statements)

References 12 publications

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“…Lachman et al 14 stated that the improvement in patient-reported outcome measures after revision TAA was significantly smaller than after primary TAA. Egglestone et al 27 and Behrens et al 12 demonstrated good short-term and medium-term improvements in patient-reported outcome measures with revision TAA. However, no preoperative scores were reported by those authors.…”

Section: Discussionmentioning

confidence: 97%

“…This will inevitably increase the volume of failed TAAs. Treatment of a failed TAA is challenging and the options include revision TAA, ankle arthrodesis [27][28][29] , ankle-hindfoot arthrodesis 30,31 , and amputation. Arthrodesis has been considered the gold standard; however, its variable functional outcomes have thrown doubt over this assertion [27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis

Jamjoom

Siddiqui

Salem

et al. 2022

Journal of Bone and Joint Surgery

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Background:The literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. In this study, we aimed to report the clinical and radiographic outcomes of revision TAA at a high-volume center in the United Kingdom.Methods:This study was a retrospective review of 28 patients who underwent 29 revision TAAs using the INBONE II Total Ankle System (Wright Medical Technology/Stryker). Demographic, radiographic, and patient-reported outcome measure data were analyzed.Results:The mean duration from primary TAA to revision was 87.5 months (range, 16 to 223 months). The main indication for the revision was aseptic loosening after the primary TAA (83%). Additional procedures were required in 76% of ankles. At a mean follow-up of 40 months (range, 24 to 60 months), the infection rate was 7%, the reoperation rate was 7%, and the implant survival rate was 97%. A significant postoperative improvement in the radiographic component alignment measures was observed. The subsidence, loosening, and heterotopic ossification rates in this study were comparable with those in other reports and did not influence the clinical outcome. A significant improvement was observed in the Manchester-Oxford Foot Questionnaire (MOXFQ) in all domains and the EuroQol-5 Dimensions (EQ-5D) in 3 domains at 24 months postoperatively.Conclusions:Revision TAA using the INBONE II prosthesis was associated with good short-term survival and improvement in postoperative scores at 2 years. Maintenance of the postoperatively improved alignment was documented at the follow-up. The results of this study support the notion that revision TAA is a satisfactory option for failed primary TAA.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis

Jamjoom

Siddiqui

Salem

et al. 2022

Journal of Bone and Joint Surgery

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“…Behrens et al reported on a series of 18 patients who underwent revision with the INBONE prosthesis; survival was 78% at 4 years, but the results may have been affected by the high rate of preoperative osteolysis 5 . Egglestone et al, also utilizing the INBONE prosthesis, revised 21 failed total ankle replacements, with 87% 4-year survival and improved patient-reported outcome measures at 2 years 6 . Finally, Lachman et al evaluated 52 TAA cases requiring implant revision, utilizing the INBONE I or II implants in nearly 80% of patients, with 3 years of follow-up and a 21% failure rate; the patient-reported outcome measures for the patients who underwent revision did not rise to the levels seen with primary procedures 7 .…”

Section: Commentarymentioning

confidence: 99%

Failed Total Ankle Arthroplasty and Our Expanding Shoreline of Peril

Benthien

2022

Journal of Bone and Joint Surgery

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The ascendency of total ankle arthroplasty (TAA) over the past several decades, from a niche procedure to the gold-standard treatment for ankle arthritis, has been remarkable to watch. Although total ankle replacement was initially viewed with suspicion regarding its design, durability, and functionality, a newly trained orthopaedic foot and ankle surgeon enters practice employing TAA as a safe, effective, and first-line treatment 1,2 . This new regime has been built on the efforts of skilled clinicians and inquisitive researchers from around the world and is an accomplishment for which we, as a community, should all take pride.As clinicians, we are constantly reminded that with success must come failure, and that dichotomy holds true for TAA. The failure of a joint replacement is a considerable emotional and economic burden for patients and a similar burden for both surgeons and health systems. The failure rate, defined as implant revision or conversion to arthrodesis, can be as high as 10% in the first 5 years and can approach 20% at ‡10 years 3,4 . As is true with all retrospective assessments, the results may not reflect the current state of the art with respect to technique, technology, and outcomes, but prudence and humility would not have us dismiss the results of such studies out of hand, as they serve as benchmarks for ongoing improvement.In their present study, Jamjoom et al. detail the revision of 29 failed TAA cases with the INBONE II prosthesis, a fixedbearing implant with intramedullary tibial fixation and cross-linked polyethylene. The results were generally excellent and on par with primary procedures, with implant survival of 97%, albeit at a follow-up of just over 3 years 1,2 . The authors deserve particular recognition for their prospective collection of patient-reported outcome measures, the Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol-5 Dimensions (EQ-5D), which demonstrated progressive functional improvement up to 24 months postoperatively. Complications were remarkably low, with just 1 nerve injury and 1 postoperative infection treated with debridement and implant retention. A concern is the 28% rate of talar component subsidence of ‡5 mm at the latest followup, which will require ongoing scrutiny.The available literature on the revision of TAA is sparse and, where available, includes small numbers and limited follow-up. Behrens et al. reported on a series of 18 patients who underwent revision with the INBONE prosthesis; survival was 78% at 4 years, but the results may have been affected by the high rate of preoperative osteolysis 5 . Egglestone et al., also utilizing the INBONE prosthesis, revised 21 failed total ankle replacements, with 87% 4-year survival and improved patient-reported outcome measures at 2 years 6 . Finally, Lachman et al. evaluated 52 TAA cases requiring implant revision, utilizing the INBONE I or II implants in nearly 80% of patients, with 3 years of follow-up and a 21% failure rate; the patient-reported outcome measures for the patients who underwent revis...

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“…Nonunion rates of arthrodesis after failed TAR range from 11% to 42%, 48,52,59 and postoperative outcomes are typically less favorable in this situation compared to those after primary TAR. 56,83 While 1 recent study reported better patient-reported outcomes after revision TAR compared to salvage arthrodesis, 22 there is no clear consensus in the literature demonstrating clear benefit of revision TAR over arthrodesis. 56 When nonreconstructible subsidence of the talar component into the subtalar joint or massive talar bone loss is encountered, TTC fusion can be performed.…”

Section: Is There Subsidence/loosening?mentioning

confidence: 99%

Evaluating and Managing the Painful Total Ankle Replacement

et al. 2021

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The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation. Level of Evidence: Level V, expert opinion or review.

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Outcomes of revision surgery for failed total ankle replacement: revision arthroplasty versus arthrodesis

Cited by 22 publications

References 12 publications

Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis

Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis

Failed Total Ankle Arthroplasty and Our Expanding Shoreline of Peril

Evaluating and Managing the Painful Total Ankle Replacement

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