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Foot Ankle Spec. 2015 Apr;8(2):143-51. doi: 10.1177/1938640014565046. Epub 2015 Jan 5.

Ankle arthrodesis after failed total ankle replacement: a systematic review of the literature.

Author information

1
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.
2
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).

Abstract

PURPOSE:

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%.

CONCLUSION:

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.

LEVELS:

Level IV: Systematic Review of Level IV Studies.

KEYWORDS:

amputation and limb salvage; arthritis and joint disease; comorbid conditions; comparative diagnostic studies; diagnostic and therapeutic techniques; joint replacement

PMID:
25561701
DOI:
10.1177/1938640014565046
[Indexed for MEDLINE]

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