title: Outcome After Salvage Arthrodesis for Failed Total Ankle Replacement.
abstract: BACKGROUND
  In cases with total ankle replacement (TAR) failure, a decision between revision TAR and salvage arthrodesis (SA) must be made. In a previous study, we analyzed revision TAR and found low functional outcome and satisfaction. The aims of the current study were to analyze SA concerning failure rate and patient-related outcome measures (PROMs).
  
  
  METHODS
  Until September 2014, a total of 1110 primary TARs were recorded in the Swedish Ankle Registry. Of the 188 failures, 118 were revised with SA (and 70 with revision TAR). Patient- and implant-specific data for SA cases were analyzed as well as arthrodesis techniques. Failure of SA was defined as repeat arthrodesis or amputation. Generic and region-specific PROMs of 68 patients alive with a solid unilateral SA performed more than 1 year before were analyzed.
  
  
  RESULTS
  The first-attempt solid arthrodesis rate of SA was 90%. Overall, 25 of 53 (47%) patients were very satisfied or satisfied. Mean Self-reported Foot and Ankle Score (SEFAS) was 22 (95% confidence interval 20-24), Euro Qol-5 Dimensions 0.57 (0.49-0.65), Euro Qol-Visual Analogue Scale 59 (53-64), Short Form-36 physical 34 (31-37) and mental 50 (46-54). The scores and satisfaction were similar to those after revision TAR but the reoperation rate was significantly lower in SA (P < .05).
  
  
  CONCLUSIONS
  Salvage arthrodesis after failed TAR had a solid arthrodesis rate of 90% at first attempt, but similar to revision TAR, less than 50% of the patients were satisfied and the functional scores were low. Until studies show true benefit of revision TAR over SA, we favor SA for failed TAR.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden ilka.kamrad@med.lu.se.
authors.forename: Ilka
authors.initials: I
authors.lastname: Kamrad
authors.affiliation: Department of Orthopedics, Falu Central Hospital, and Center of Clinical Research Dalarna, Falun, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Henricson
authors.affiliation: Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Magnusson
authors.affiliation: Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Carlsson
authors.affiliation: Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden.
authors.forename: Björn E
authors.initials: BE
authors.lastname: Rosengren
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D013548:Sweden
keywords: PROM; ankle arthritis; failed total ankle replacement; failure rate; outcome; revision TAR; salvage arthrodesis; satisfaction