title: Intraoperative and perioperative complications during revision arthroplasty for salvage of a failed total ankle arthroplasty.
abstract: BACKGROUND
  Revision of a failed total ankle arthroplasty (TAA) remains a challenge. Advances in total ankle implant design have renewed interest in revision TAA as an alternative to ankle arthrodesis or amputation in the management of a failed TAA. The purpose of our study was to review a series of failed Agility TAA revised to INBONE II TAA and identify reasons for revision as well as perioperative complications.
  
  
  METHODS
  A retrospective review of 35 cases of failed Agility TAA revised to an INBONE II TAA was performed at 1 institution. Patient demographics, indications for revision, radiographs, and complications were reviewed. The average follow-up was 9.1 months (range, 0-28 months). All revisions were performed by 1 of 2 foot and ankle surgeons familiar with both prostheses.
  
  
  RESULTS
  The Agility TAA lasted a mean of 6.7 years prior to revision to an INBONE II TAA. Revision TAA was indicated due to mechanical loosening, osteolysis, periprosthetic fracture, and a dislocated prosthesis. Adjunctive procedures were performed in 31 of 35 cases. There were 6 intraoperative and 5 acute postoperative complications, leading to an overall 31.4% complication rate. There was 1 patient with continued pain postoperatively who underwent a second revision of the INBONE II 20 months postoperatively.
  
  
  CONCLUSIONS
  Revision TAA was a viable treatment option for failed TAA. A high risk of perioperative complications remains, and physicians should be aware of the challenges that occur during these procedures in order to plan for them preoperatively.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, UCLA, Santa Monica, CA, USA joanryanwilliams@gmail.com.
authors.forename: Joan R
authors.initials: JR
authors.lastname: Williams
authors.affiliation: Harborview Medical Center, Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wegner
authors.affiliation: Harborview Medical Center, Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Sangeorzan
authors.affiliation: Harborview Medical Center, Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Brage
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy
keywords: ankle arthritis; revision ankle arthroplasty; total ankle arthroplasty