SLR - August 2010 - JoAnn Marie Zotis

Takedown of Ankle Fusion and Converstion to Total Ankle Replacement

Reference: 
Greisberg  J, Assa M, Flueckiger G, Hansen S: Takedown of Ankle Fusion and Conversion to Total Ankle Replacement.  Clinical Orthopaedics and Related Research  424:80-88, 2004.

Scientific Literature Reviews

Reviewed by:  JoAnn Marie Zotis, DPM
Residency Program: University Hospitals Health Systems/Ohio College of Podiatric Medicine

Podiatric Relevance:
The article presents total ankle replacement as an effective option for treating ankle pain due to a problematic ankle arthrodesis.This is presented as an alternative to transtibial amputation.

Methods:
The study presents a retrospective analysis of takedown of 23 ankle fusions (22 patients) with conversion to total ankle replacement betwee April 1996 and August 2001.  The procedure was performed on patients that previously  underwent ankle fusion without lateral malleolar resection.  Evaluation of intra operative and post operative ROM were assessed. Also,  pre-operative and post-operative AOFAS scores were recorded. Patients were divded into two subgroups for evaluation: Group 1 had a clear source of pain such as symptomatic subtalar joint or non union, while Group 2 had pain of uncertain origin in a well-healed, well-aligned joint, with no degenerative disease.  

Results: 
23 ankle replacements were performed in 22 patients. Four patients could not be located for follow-up. This left 19 ankles in 18 patients for the final analysis. Transtibial amputation was successfully avoided in 15 patients (16 ankles). Following the procedure, 9 ankles in 9 patients did not have additional surgery . Ten ankles underwent reoperation including single and multiple revisions of the total ankle arthroplasty, calcaneal osteotomy to treat valgus deformity, medial column reconstructions, and conversion back ankle arthrodesis.Three patients underwent transtibial amputation resulting from continued pain.The mean AOFAS ankle/hind foot score improved from 42 to 68 in patients not undergoing amputation. Patients from Group 1 (clear source of pain) demonstrated higher final AOFAS score than patients from Group 2 (no clear source of pain). 

Conclusions:
Takedown of a problematic ankle fusion and conversion to total ankle arthroplasty was successful in improving pain in most ankles, and therefore can be considered as an alternative to transtibial amputation.

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