Aseptic loosening of total ankle replacement and conversion to ankle arthrodesis

• Published in: Operative Orthopädie und Traumatologie Vol. 29; no. 3; pp. 207 - 219
• Main Authors: Wimmer, M D, Hettchen, M, Ploeger, M M, Hintermann, B, Wirtz, D C, Barg, A
• Format: Journal Article
• Language: German
• Published: Germany 01.06.2017
• Subjects: Aged; Ankle Joint - diagnostic imaging; Ankle Joint - surgery; Arthrodesis - instrumentation; Arthrodesis - methods; Arthroplasty, Replacement, Ankle - adverse effects; Arthroplasty, Replacement, Ankle - instrumentation; Female; Humans; Joint Instability - etiology; Joint Instability - surgery; Male; Middle Aged; Prosthesis Failure; Reoperation - instrumentation; Reoperation - methods; Treatment Outcome; Talocalcaneal joint; Tarsal bones; Ankle replacement arthroplasty; Revision surgery; Subtalar joint
• ISSN: 1439-0981
• DOI: 10.1007/s00064-017-0492-x

To remove loosened prosthesis components, to perform augmentation, to address osseous defects, to perform neutrally aligned ankle arthrodesis, and to achieve postoperative pain relief. Symptomatic, aseptic loosening of total ankle replacement (TAR) with/without substantial bone defect of the tibial and/or talar bone stock. General surgical or anesthesiological risks, periprosthetic infection, local or systemic infection, nonmanageable soft tissue problems. Removal of both prosthesis components using the previous incision (mostly using anterior ankle approach). Careful debridement of bone stock at the tibial and talar side. Osseous augmentation of defects using autologous or homologous cancellous bone, if needed, using structural allografts. A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6-8 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually after progressive osseous healing has been confirmed. Between January 2007 and December 2012, ankle arthrodesis was performed in 9 patients with failed TAR (6 men and 3 women, mean age 56.4 ± 7.0 years, range 47.8-66.0 years). The mean time between the initial TAR and revision surgery was 4.5 ± 2.4 years (range 1.2-7.9 years). In one patient irrigation and debridement was performed due to superficial wound infection. Another patient had a delayed osseous healing 11 months after the revision surgery.