Circular External Fixator-Assisted Ankle Arthrodesis Following Failed Total Ankle Arthroplasty
ABSTRACT Failed total ankle arthroplasty (TAA) often results in significant bone loss and requires salvage arthrodesis. This study quantified the bone loss following failed TAA and reports the outcome of seven arthrodesis reconstructions using the Ilizarov method.
A retrospective review of ankle fusions was performed for failed TAA to collect the mode of implant failure, presenting limb length discrepancy (LLD), total bone defect, postarthrodesis LLD, and treatment type (shoe lift versus distraction osteogenesis) and amount (shoe lift or lengthening).
Four mechanical failures and three infections were found. Four of seven cases had prior revision TAAs. Four of seven patients were treated with tibiotalar arthrodesis; three of the seven patients required talar resection and tibiocalcaneal arthrodesis. The mean presenting LLD was 2.2 (range, 1.2 to 3.5) cm. The mean time in frame was 197 (range, 146 to 229) days. With a mean postexplantation total bone defect of 5.1 (range, 3.7 to 8.5) cm, four of seven patients elected tibial lengthening following fusion [mean lengthening 4.6 (range, 2.5 to 8.0) cm; external fixation index (EFI) 42.6 (range, 16.5 to 55.6) days/cm)]. Three of seven patients were treated with a shoe lift [mean lift height 2.9 (range 2.5 to 3.2) cm]. There was no failure of fixation, refracture, or infection. All patients had a stable plantigrade foot and walked with minimal limp. Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores were six good and one fair. ASAMI bone scores were four excellent and three good.
Ankle arthrodesis following failed TAA results in large LLDs secondary to bone loss during implant failure and subsequent explantation. External fixation can produce an excellent fusion rate in complex, possibly infected, failed TAAs. Limb length equalization (by either distraction osteogenesis or shoe lift) provides a means of obtaining good functional outcomes following failed TAA.
Article: Peritalar instability.Foot & Ankle International 05/2012; 33(5):450-4. DOI:10.3113/FAI.2012.0450 · 1.63 Impact Factor
- Fuß & Sprunggelenk 11/2013; 11(4):177-178. DOI:10.1016/j.fuspru.2013.10.001
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ABSTRACT: In the last two decades enormous improvements were observed regarding total ankle replacement. With increased use of this therapeutic option the number of prosthesis failures may also increase. The most common reason for total ankle replacement failure is aseptic loosening of one or both metallic components. Up to now, conversion of failed ankle to ankle arthrodesis was considered to be gold standard treatment option. However, in the past revision arthroplasty can be also used in this patient cohort. Depending on osseous defects the revision total ankle replacement can be performed as one-stage or two-stage procedure.Fuß & Sprunggelenk 12/2013; 11(4):228–237. DOI:10.1016/j.fuspru.2013.09.006
Thomas H McCoy