Salvage arthrodesis for failed total ankle arthroplasty

Figures & data

Demographic, perioperative, and outcome data on all salvage procedures

A	B	C	D	E	F	G	H	I	J	K	L	M
1	F	27	JIA	LCS	Loosening	161	Ankylosis	TTC	Screws	Allo	Nonunion	–
2 ^a	F	49	RA	LCS	Instability	83	Arthritis	TT	Blade plate	AuP	3	–
3 ^a	M	63	RA	LCS	Deformity	103	Normal	TT	Blade plate	AuL	4	–
4 ^a	F	58	RA	LCS	Loosening	115	Fusion	TTC	K-wires	Allo	Nonunion	–
5 ^a	F	66	RA	LCS	Deformity	25	Ankylosis	TTC	Screws	AuP	10	–
6 ^a	M	51	RA	LCS	Deformity	51	Fusion	TTC	Blade plate	AuL	2	–
7	F	60	RA	BP	Deformity	44	Fusion	TTC	Nail	AuL	16	Nail dynamization
8	F	43	RA	BP	Postop. malleolar fracture	42	Fusion	TTC	Nail	AuFH (deep-frozen)	Nonunion	–
9 ^a	F	71	RA	BP	Instability	20	Fusion	TTC	Screws	AuP	Nonunion	Repeat arthrodesis
10	F	41	RA	BP	Infection	4	Arthritis	TT	Screws	AuL	3	–
11	M	51	RA	BP	Loosening	40	Fusion	TTC	Nail	AuP	Nonunion	2 Repeat arthrodeses
12	F	73	RA	BP	Loosening	50	Arthritis	TTC	Nail	AuP	Nonunion	Repeat arthrodesis
13	F	45	RA	BP	Loosening	31	Ankylosis	TTC	Nail	AuL	9	Nail removal
14	M	55	OA	BP	Pain	61	Normal	TT	Blade plate	AuL	2	–
15 ^b	F	76	RA	BP	Wound dehiscence	2	Arthritis	TTC	Nail	None	Nonunion	Repeat arthrodesis
16	F	47	OA	BP	Pain	39	Normal	TT	Blade plate	AuL	4	–
17	F	46	NsO	BP	Wound dehiscence	6	Normal	TT	Blade plate	AuP	4	Plate removal
18	F	61	OA	CCI	Intraop. malleolar fracture	3	Normal	TT	Blade plate	Allo + AuL 10	–

A Case no.

  ^a Patients who died before 2008 with no clinical scores at follow-up.

  ^b Patient wheelchair-bound; no clinical scores at follow-up.

B Sex

C Age at TAA

D Diagnosis

  JIA: juvenile idiopathic arthritis;

  RA: rheumatoid arthritis;

  NsO: non-specific oligoarthritis;

  OA: osteoarthritis.

E Prosthesis

  LCS = New Jersey low contact stress;

  BP: Buechel-Pappas;

  CCI: ceramic-coated implant.

F Failure scenario

G Interval since TAA (months)

H Subtalar joint

I Type of fusion

  TT: Tibio-talar;

  TTC: tibio-talocalcaneal.

J Fixation

K Type of bone graft

  Allo: allograft;

  AuL: autologous bone graft harvested locally;

  AuP: autologous bone graft from pelvis;

  AuFH: autologous bone graft from deepfrozen femoral head.

L Time to fusion (months)

M Secondary surgery

Figure 1.  A 63-year-old man (case 3) with long-standing RA and a preoperative varus deformity of the ankle of 20 degrees. A. After implantation of an LCS prosthesis. There is a persistent varus deformity and edge-loading of the prosthesis. B and C. After conversion to tibiotalar arthrodesis. The arthrodesis was stabilized by a humeral blade plate, implanted at the lateral side. Debris originating from the edge-loading of the metallic components is visible at the arthrodesis site.

Figure 2.  A 43-year-old woman (case 8) with RA had a Buechel-Pappas prosthesis implanted. She had a preoperative valgus deformity of 10 degrees. A. 3 years postoperatively, when, due to a malleolar insufficiency fracture, a recurrent valgus deformity with edge-loading of the prosthesis had developed. B. A tibio-talocalcaneal arthrodesis was performed, stabilized by a retrograde intramedullary locking nail. C. 2 years after the salvage procedure, the nail had been removed. 6 years later, there was a fibrous nonunion. The ankle was fairly asymptomatic and did not require a second-attempt procedure.