title: Salvage of Failed Total Ankle Replacement Using a Custom Titanium Truss.
abstract: Subsidence of the talar component results in significant morbidity after total ankle replacement. When recognized, prompt revision could be needed to preserve the function of the implant; however, this is not always the case. In situations in which the implant cannot be revised, tibiotalocalcaneal arthrodesis might be necessary to salvage the extremity. The purpose of the present report is to describe the use of a custom titanium alloy truss to fill a bony void created by explantation of the implant components. Total ankle replacement was performed as the initial surgery to address end-stage osteoarthritis. Two years after the index procedure, the patient underwent revision of the polyethylene and talar components with subtalar arthrodesis secondary to progressive subtalar osteoarthritis and talar subsidence. The implant subsequently became infected and was removed. The patient underwent re-implantation after the infection had resolved, but significant talar subsidence required conversion to a tibiotalocalcaneal arthrodesis with a custom titanium alloy truss and retrograde intramedullary nail. At the most recent follow-up appointment, the patient was weightbearing on a stable extremity and pain free. Radiographic examination confirmed appropriate implant alignment and evidence of bone formation throughout the titanium truss. Although our results are restricted to a single case with initial, limited follow-up data, combining sound structural mechanics with an open architecture and unique texture, the custom titanium truss appears to maintain the limb length and promote healing across a large void.
authors.affiliation: Fellow, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mulhern
authors.affiliation: Research Associate, Department of Clinical Education and Research, Coordinated Health, Allentown, PA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Protzman
authors.affiliation: Resident, Podiatric Residency Program, New York Methodist Hospital, Brooklyn, NY.
authors.forename: Amari M
authors.initials: AM
authors.lastname: White
authors.affiliation: Fellowship Director, Foot and Ankle Reconstruction, and Department Chair, Foot and Ankle Department, Coordinated Health, Bethlehem, PA; and Clinical Professor of Surgery, Clinical Sciences Department, The Commonwealth Medical College, Scranton, PA. Electronic address: drsbrigido@mac.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brigido
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011474:Prosthesis Design; D011859:Radiography / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D016879:Salvage Therapy / Q000295:instrumentation* / Q000379:methods; D014025:Titanium; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D014025:Titanium
keywords: ankle osteoarthritis; arthrodesis; revision; salvage; total ankle arthroplasty