Introduction:. We report the outcomes of salvage procedures in total ankle replacement (TAR) in a single surgeon series. Methods:. This study was a retrospective review of patients who had undergone salvage procedures with tibio-talo-calcaneal (TTC) fusion for failed TAR over a period from 1999–2013 in a single centre. In this period, 317 TAR were performed of which 11 have failed necessitating conversion to TTC fusion. Clinical documentation and radiographs were reviewed for cause of failure, type of graft for fusion, time to radiological/clinical union and complications including further surgeries. Results:. The causes of failure of the TAR were pain from instability/impingement in 8, fracture in one, subsidence of the talar component in one and infection in one. From the group of 11 patients, 8 patients went onto union at a mean of 10 months (7–14). All 8 patients had femoral head structural allografts to maintain limb length for the procedure and 3 required a secondary procedure to dynamise the nail. 2 patients with femoral head structural allografts developed infections necessitating removal of the graft and conversion to an external fixator of which one united and the other developed a painless fibrous union. 1 patient developed non-union with progressive deformity of the ankle resulting in a Symes amputation. Conclusions:. From our series of patients we have demonstrated that failure of TAR requiring salvage procedures is a relatively rare event (3.5%). The use of TTC fusion is successful in the majority of patients and the use of femoral head structural allografts allows preservation of
The aim of this study was to present a series of patients with
aseptic failure of a total ankle arthroplasty (TAA) who were treated
with fusion of the hindfoot using a nail. A total of 23 TAAs, in 22 patients, were revised for aseptic
loosening and balloon osteolysis to a hindfoot fusion by a single
surgeon (NH) between January 2012 and August 2014. The procedure
was carried out without bone graft using the Phoenix, Biomet Hindfoot
Arthrodesis Nail. Preoperative investigations included full blood
count, CRP and ESR, and radiological investigations including plain
radiographs and CT scans. Postoperative plain radiographs were assessed
for fusion. When there was any doubt, CT scans were performed.Aims
Patients and Methods
The surgical management of ankle arthritis with tibiotalar arthrodesis
is known to alter gait, as compared with normal ankles. The purpose
of this study was to assess post-operative gait function with gait
before arthrodesis. We prospectively studied 20 patients who underwent three-dimensional
gait analysis before and after tibiotalar arthrodesis. Cadence,
step length, walking velocity and total support time were assessed.
Kinetic parameters, including the moment and power of the ankle
in the sagittal plane and hip power were also recorded.Aims
Patients and Methods
This retrospective cohort study compared the results of vascularised
and non-vascularised anterior sliding tibial grafts for the treatment
of osteoarthritis (OA)of the ankle secondary to osteonecrosis of
the talus. We reviewed the clinical and radiological outcomes of 27 patients
who underwent arthrodesis with either vascularised or non-vascularised
(conventional) grafts, comparing the outcomes (clinical scores,
proportion with successful union and time to union) between the
two groups. The clinical outcome was assessed using the Mazur and
American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot
scores. The mean follow-up was 35 months (24 to 68).Aims
Patients and Methods
Achieving arthrodesis of the ankle can be difficult
in the presence of infection, deformity, poor soft tissues and bone loss.
We present a series of 48 patients with complex ankle pathology,
treated with the Ilizarov technique. Infection was present in 30
patients and 30 had significant deformity before surgery. Outcome
was assessed clinically and with patient-reported outcome measures
(Modified American Orthopaedic Foot and Ankle Society (MAOFAS) scale and
the Short-Form (SF-36)). Arthrodesis was achieved in 40 patients with the Ilizarov technique
alone and in six further patients with additional surgery. Infection
was eradicated in all patients at a mean follow-up of 46.6 months
(13 to 162). Successful arthrodesis was less likely in those with
comorbidities and in tibiocalcaneal fusion compared with tibiotalar
fusion. These patients had poor general health scores compared with the
normal population before surgery. The mean MAOFAS score improved
significantly from 24.3 (0 to 90) pre-operatively to 56.2 (30 to
90) post-operatively, but there was only a modest improvement in
general health; the mean SF-36 improved from 44.8 (19 to 66) to
50.1 (21 to 76). There was a major benefit in terms of pain relief. Arthrodesis using the Ilizarov technique is an effective treatment
for complex ankle pathology, with good clinical outcomes and eradication
of infection. However, even after successful arthrodesis general
health scores remain limited. Cite this article:
Salvage of a failed total ankle replacement is technically challenging and although a revision procedure may be desirable, a large amount of bone loss or infection may preclude this. Arthrodesis can be difficult to achieve and is usually associated with considerable shortening of the limb. We describe a technique for restoring talar height using an allograft from the femoral head compressed by an intramedullary nail. Three patients with aseptic loosening were treated successfully by this method with excellent symptomatic relief at a mean follow-up of 32 months (13 to 50).
