title: Ankle arthrodesis after failed total ankle replacement: a systematic review of the literature.
abstract: OBJECTIVE
  As the number of total ankle replacements (TARs) performed has risen, so has the need for revision. The purpose of this investigation was to perform a systematic review of clinical outcomes following a salvage ankle arthrodesis from a failed TAR to identify patient- and technique-specific prognostic factors and to determine the clinical outcomes and complications following an ankle arthrodesis for a failed TAR.
  
  
  METHODS
  We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for studies that analyzed ankle fusion after failed TAR with a minimum follow-up of 1 year.
  
  
  RESULTS
  We included 16 studies (193 patients). The majority of patients (41%) underwent the index TAR for rheumatoid arthritis. The majority of these revision surgeries were secondary to component loosening, frequently of the talar component (38%). In the cases that were revised to an ankle arthrodesis, 81% fused after their first arthrodesis procedure. The intercalary bone graft group and the blade plate group had the highest rate of fusion after the first attempt at fusion at 100%, whereas the tibiotalocalcaneal fusion with cage group had the lowest fusion rate at 50%. The overall complication rate was 18.2%, whereas the overall nonunion rate was 10.6%.
  
  
  CONCLUSIONS
  A salvage ankle arthrodesis for a failed TAR results in favorable clinical end points and overall satisfaction at short-term follow-up if the patients achieve fusion. The bone graft fusion and blade plate group resulted in the highest first-attempt fusion rate, with a low complication rate. Future studies should include prospective, comparative control or surgical groups and use standardized outcome measurements that will make direct comparisons easier.
  Level IV: Systematic Review of Level IV Studies.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP) cgross144@gmail.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gross
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP).
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP).
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Adams
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP).
authors.forename: Selene G
authors.initials: SG
authors.lastname: Parekh
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects*; D006801:Humans; D010003:Osteoarthritis / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: amputation and limb salvage; arthritis and joint disease; comorbid conditions; comparative diagnostic studies; diagnostic and therapeutic techniques; joint replacement