RESEARCH - The management of failed ankle replacement

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J Bone Joint Surg Br. 2006 Aug;88(8):1039-47.

The management of failed ankle replacement.

Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK.

rkotnis@...

Advances in the design of the components for total ankle replacement have

led to a resurgence of interest in this procedure. Between January 1999 and

December 2004, 16 patients with a failed total ankle replacement were

referred to our unit. In the presence of infection, a two-stage salvage

procedure was planned. The first involved the removal of the components and

the insertion of a cement spacer. Definitive treatment options included

hindfoot fusion with a circular frame or amputation. When there was no

infection, a one-stage salvage procedure was planned. Options included

hindfoot fusion with an intramedullary nail or revision total ankle

replacement. When there was suspicion of infection, a percutaneous biopsy

was performed. The patients were followed up for a minimum of 12 months. Of

the 16 patients, 14 had aseptic loosening, five of whom underwent a revision

total ankle replacement and nine a hindfoot fusion. Of the two with

infection, one underwent fusion and the other a below-knee amputation. There

were no cases of wound breakdown, nonunion or malunion. Management of the

failed total ankle replacement should be performed by experienced surgeons

and ideally in units where multidisciplinary support is available.

Currently, a hindfoot fusion appears to be preferable to a revision total

ankle replacement.

PMID: 16877603

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16877603

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