Arthrodesis After Failed Total Ankle Replacement.
BACKGROUND
The literature on salvage procedures for failed total ankle replacement (TAR) is sparse. We report a series of 17 patients who had a failed TAR converted to a tibiotalar or a tibiotalocalcaneal arthrodesis.


METHODS
Between 2003 and 2012, a total of 17 patients with a failed TAR underwent an arthrodesis. All patients were followed on a regular basis through chart review, clinical examination and radiological evaluation. The following variables were analyzed: pre- and postoperative Meary angle, cause of failure, method of fixation, type of graft, time to union, complications, and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score. The average follow-up was 30.1 months. The average period from the original arthroplasty to the arthrodesis was 49.8 months.


RESULTS
Thirteen of the 17 ankles were considered radiographically healed after the first attempt in an average time of 3.7 months and 3 after repeat arthrodesis. Bone grafts were used in 16 patients. The median postoperative AOFAS score was 74.5. The mean Meary angle of the hindfoot was 5 degrees of valgus.


CONCLUSIONS
Tibiotalar and tibiotalocalcaneal arthrodeses were effective salvage procedures for failed TAR. Massive cancellous allografts were a good alternative to compensate for the large bone defect after removal of the prosthesis and to preserve the leg length.


METHODS
Level IV, retrospective case series.
1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium.|2 Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Belgium.
Paul-André
PA
Deleu
1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium.
Bernhard
B
Devos Bevernage
1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium.
Pierre
P
Maldague
1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium.
Vincent
V
Gombault
1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium.
Thibaut
T
Leemrijse
bone grafts; tibiotalar arthrodesis; tibiotalocalcaneal arthrodesis; total ankle replacement