Salvage of failed total ankle replacement using tantalum trabecular metal: case series.
BACKGROUND
Although newer generations of total ankle arthroplasty designs have better clinical outcomes, failure due to aseptic loosening remains a frequent major complication. Arthrodesis is the most common salvage procedure for a failed total ankle replacement. There are several arthrodesis techniques each with its advantages and disadvantages. We present a technique of ankle arthrodesis for failed total ankle replacements using tantalum Trabecular Metal™ (Zimmer, Warsaw, IN) with internal fixation, thus sparing the subtalar joint.


METHODS
Three patients who had undergone arthrodesis for a failed total ankle replacement using tantalum Trabecular Metal were retrospectively reviewed. The mean follow-up period was 57 (range, 31-86) months. The mean age at ankle arthroplasty was 57 (range, 33-72) years and at ankle arthrodesis was 63 (range, 44-74) years. The mean time from arthroplasty to arthrodesis was 7 (range, 2-11) years.


RESULTS
The American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 30.7 (range, 20-39) preoperatively to 72.7 (range, 65-77) postoperatively at the time of last follow-up. Arthrodesis was achieved at a mean of 3 months, and there were no complications.


CONCLUSIONS
The technique described has several advantages when compared to other methods of salvage ankle arthrodesis. The subtalar joint is not included in the fusion unless it is degenerative and symptomatic. Height of the ankle is maintained throughout the fusion process. Furthermore, Trabecular Metal is abundantly available; it avoids donor site morbidity and eliminates the risk of transmissible diseases.
American University of Beirut Medical Center, Beirut, Lebanon bernard.sagherian@aub.edu.lb.
Bernard H
BH
Sagherian
Mayo Clinic Arizona, Phoenix, AZ, USA.
Richard J
RJ
Claridge
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D006801:Humans; D007595:Joint Prosthesis; D008875:Middle Aged; D016059:Range of Motion, Articular; D012086:Reoperation; D016879:Salvage Therapy / Q000379:methods*; D013635:Tantalum; D016474:Weight-Bearing
D013635:Tantalum
allograft; arthrodesis; aseptic loosening; autograft; complications; failed total ankle; internal fixation; porous tantalum; structural graft; total ankle arthroplasty; total ankle replacement