Title: Ankle Arthrodesis for failed Total Ankle Replacement
Authors: P. Hopgood, MD; R. Kumar, MD, Peter Wood, MD
Source: Journal of Bone & Joint Surgery (British Edition), August 2006, 1032-1038
PODIATRIC RELEVANCE:
Surgical Correction of the failed ankle joint prostheses represents a difficult reconstructive dilemma for the podiatric surgeon. This article investigates several options for treating this patient population.
METHODS:
Between 1999 and 2005, 23 failed total ankle replacements were converted to arthrodeses. Mean age was 62 years. OA in 12 cases and RA in 11. In all cases, the implants were removed, joints debrided to viable bone, Tibio-Talar compression was achieved with placement of either synthetic or autogenous bone graft. Three surgical techniques were used in all: 8 patients underwent tibiotalar arthrodesis with 6.5mm screw fixation, 5 patients had tibiotalocalcaneal arthrodesis with 6.5 mm screw fixation, and 10 patients received a tibiotalocalcaneal arthrodesis with intramedullary nail. Patients were placed in either a below-knee cast or a rigid orthopedic walker boot for 15 weeks.
RESULTS:
Mean follow-up was 29 months. Successful bony union was seen in 17 of the 23 fusions with a mean time to fusion of 15 weeks using clinical and radiographic criteria. Eight patients with OA having tibiotalar arthrodesis with screw fixation went on to satisfactory unions. Eight of the ten ankles having tibiotalocalcaneal arthrodeses with IM nail united, but poor results occurred in seven cases when screw fixation was used. Patients were assessed in a clinical review, where the mean AOFAS hindfoot score which assesses function and pain was 61/80. Problems in the surrounding joints affecting overall mobility contributed to the low scores. Of the 7 patient unions, 15 were satisfied, one somewhat satisfied, one dissatisfied. Eight had no pain, Five mild pain and four moderate.
COMMENTS:
TAR’s are increasing due the increased demand of the aging and obese population and with the recent advances in implant design and improved surgeon training. Although failures still exists, this article shows that effective reconstructive options available to help restore function and reduce pain.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.