Advances in the design of the components for total ankle replacement have led to a resurgence of interest in this procedure.

Between January 1999 and December 2004, 16 patients with a failed total ankle replacement were referred to our unit. In the presence of infection, a two-stage salvage procedure was planned. The first involved the removal of the components and the insertion of a cement spacer. Definitive treatment options included hindfoot fusion with a circular frame or amputation. When there was no infection, a one-stage salvage procedure was planned. Options included hindfoot fusion with an intramedullary nail or revision total ankle replacement. When there was suspicion of infection, a percutaneous biopsy was performed. The patients were followed up for a minimum of 12 months.

Of the 16 patients, 14 had aseptic loosening, five of whom underwent a revision total ankle replacement and nine a hindfoot fusion. Of the two with infection, one underwent fusion and the other a below-knee amputation. There were no cases of wound breakdown, nonunion or malunion.

Management of the failed total ankle replacement should be performed by experienced surgeons and ideally in units where multidisciplinary support is available. Currently, a hindfoot fusion appears to be preferable to a revision total ankle replacement.

The resurgency of ankle replacement in the last 10 years has prompted a need for effective management of failing prostheses. We present the early to mid-term results for revision surgery of 17 arthroplasties in 17 patients from our tertiary referral centre.

Between 1999 and 2004, two Consultant Foot and Ankle Surgeons revised failing ankle arthroplasties in 17 patients (age range 51–74 years). All patients were assessed with tissue cultures and histology that were harvested at the time of surgery and managed in conjunction with a specialist Bone Infection Unit.

Intraoperative frozen section was used to aid management, but usually pre-operative decisions had been made which included

one or two stage reimplantation

Many of the patients had had previous “revision surgery” such as change of meniscal components, arthroscopic debridements and excision of impingeing osteophytes.

Indications for implantation had been osteoarthritis in 59%, rheumatoid arthritis in 18% and post-trauma in 23%. Heel shift procedures to correct malalignment had been performed in 12%.

The implants comprised 15 Scandinavian Total Ankle Replacements (STAR), one Agility and one Buechel-Pappas. Three patients had fractured malleoli secondary to bone loss.

Cultures and histology confirmed the presence of infection in 24% (defined as positive histology and more than 2/6 positive cultures) with aseptic loosening in the remainder.

One infected patient underwent amputation at his request. Six non-infected patients had successful revision of two or three components, one infected patient had Ilizarov fusion and lengthening. The remainder underwent successful hindfoot fusion over a locked intramedullary nail, even in the presence of infection, with suppression to union.