Replacing the Fusion: Conversion of an Ankle Arthrodesis to a Total Ankle Arthroplasty

Abstract

A painful ankle arthrodesis, whether from malunion, nonunion, or the development of adjacent hindfoot arthritis, can be a difficult problem for the patient and treating surgeon. Several surgical options are available, however, conversion of the arthrodesis to a total ankle replacement offers the potential for restoration of some degree of ankle motion, reduced pain, and improved overall patient function. This concept of an ankle arthrodesis takedown to total ankle replacement and the surgical technique are reviewed here in detail, along with relevant complications, available outcomes data, and the future of the technique. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Conversion of Symptomatic Ankle Arthrodesis Nonunion to Total Ankle Arthroplasty Using Patient-specific Instrumentation and Computer-assisted Surgery Guides: A Case Report

“…Usage of this technology is relatively new and we report its use as a valuable indication in the conversion of ankle fusion nonunion to an ankle replacement, which Schweitzer et al8 described with a different implant. Our case report is in agreement with the recommendations of the Schweitzer paper, and we present these as a case report highlighting these tenets of ankle fusion conversion to replacement with a different implant than that used by Schweitzer and colleagues with excellent clinical results.…”

“…Early clinical and cadaveric studies have demonstrated promising outcomes and benefits to using preoperative navigation for total ankle arthroplasty procedures including accurate, precise, and repeatable implant placement and alignment. Furthermore, decreased operative time, blood loss, and cost have also been reported when using patient-specific guides and instrumentation 8,11–14…”

“…Such complications can lead to further pain and disability, patient dissatisfaction, and surgical interventions. Surgical treatment options after symptomatic ankle arthrodesis nonunion include a revision arthrodesis or conversion to a total ankle arthroplasty 1,4–9…”

“…describing the navigation process utilizing patient-specific instrumentation and computer-assisted surgery guides for the conversion of ankle arthrodesis to arthroplasty. 8 The purpose of our case report was to describe the navigation process of a fixedbearing, computer-guided total ankle implant in a patient who developed painful, aseptic nonunion of a primary ankle arthrodesis, and underwent conversion to a total ankle arthroplasty.…”

Total ankle arthroplasty and ankle arthrodesis affect the biomechanics of the inner foot differently

“…Ankle arthrodesis, considered as the gold standard of treatments, eliminates ankle joint motion, potentially resulting in bony fracture, malalignment, nonunion, adjacent joint degeneration, and foot pain 1–5 . TAA has been advocated as an alternative because it preserves ankle joint motion 6,7 , but complications such as fracture, implant loosening, and malalignment often arise 8–11 . Studies of gait analysis 12–14 , cadaveric experiments 15,16 , physical tests, radiological examination, and pain/function scores 17,18 have compared the two surgical treatments regarding the functional outcomes and complications.…”