Introduction: The objective of this study was to investigate the clinical, radiographic and subjective outcome after salvage arthrodesis for failed total ankle arthroplasty (TAA), with a focus on salvage in inflammatory joint disease (IJD).

Methods: Between 1994 and 2005, salvage arthrodesis for failed mobile-bearing TAA was performed in 18 ankles. Primary diagnosis was IJD 15 and osteoarthritis 3. Tibiotalar fusion was performed in 7 and tibiotalocalcaneal fusion in 11 ankles (in 9 out of these, the subtalar joint was already ankylosed). Serial radiographs were studied retrospectively by an independent observer for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, by the Foot function Index and by VAS scores for pain, function and satisfaction.

Results: Blade plates were used in 7 ankles, all united. Nonunion developed in 7 IJD ankles stabilized by either a nail or screws or multiple K-wires. Revision arthrodesis was done for 4 nonunions, 3 were successful. Eleven patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. At follow-up, their mean AOFAS score was 62.4; mean overall FFI was 70.1; VAS for pain was 20.1, for function 64.3, for satisfaction 73.8.

Conclusions: Blade plate fixation is successful in salvage ankle arthrodesis. An high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Several publications on primary arthrodesis also show an elevated nonunion rate in IJD. Clinical results were relatively good. The three non-unions in follow-up had subjective results similar to the fused ankles.

Introduction: The aim of this study was to evaluate the short-term results with use of a novel mobile-bearing design for total ankle arthroplasty (TAA).

Methods: A consecutive series of 70 primary TAA in 69 patients (37 women, 32 men), replaced between 2004 and 2007 with the Ceramic Coated Implant (CCI) Evolution (Van Straten, Nieuwegein, Netherlands) prosthesis was studied prospectively. Diagnosis was: postfracture arthritis 17, instability arthritis 21 (13 combined with a varus deformity of 10°–25°), rheumatoid arthritis 25, osteoarthritis 6 and haemochromatosis 1. Mean age at surgery was 59.3 years (range 30–84). AOFAS ankle score and range of motion were assessed and survival curves calculated.

Results: At follow-up, in 2008, 2 patients had deceased. Six TAA had failed for the following reasons: deep infection 1, secondary fracture 1, and aseptic loosening of the tibial component 4 (in 2 due to an increased anterior slope of the tibial component). All four mechanical failures occurred in patients with instability arthritis. Three-year survival with revision for any reason as an endpoint was 0.90 (SE 0.04). No talar components have been revised.

AOFAS score increased from 35.6 (SD 14.4) preoperative to 82.3 at FU (p< 0.05), dorsiflexion increased from 4.9° to 8.6° (p< 0.05), plantarflexion from 27.4° to 30.9° (n.s.).

Discussion and Conclusions: Good results were obtained in patients with rheumatoid arthritis and post-fracture arthritis. Mechanical failures of the tibial component occurred in instability arthritis and were related to malposition of the tibial component. No mechanical problems related to the talar component have been encountered.