[Revision of failed ankle arthrodeses]

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction
• Arthrodesis revision

Background:

• Ankle arthrodesis failure can result from septic or aseptic causes, leading to pain and impaired weight-bearing.
• Revision surgery is necessary to address nonunion and malposition after initial ankle fusion procedures.

Purpose of the Study:

• To evaluate the efficacy of a specific surgical technique for revision ankle arthrodesis.
• To achieve bony consolidation and restore pain-free limb function with minimal leg shortening.

Main Methods:

• The surgical technique involved approaching via existing scars, resecting nonunion, removing necrotic tissue, and repositioning the talus.
• Autogenous bone grafting was utilized for major defects, with temporary Kirschner wire fixation followed by external fixator application and compression.
• Cancellous bone from the iliac crest was used for grafting if needed, followed by suction drainage and wound closure.

Main Results:

• Bony consolidation was achieved in 15 out of 16 patients (93.75%), with 14 achieving a perfect position.
• The average leg shortening was 2.8 cm, and satisfactory soft-tissue healing occurred in 12 patients.
• One patient required a repeat revision due to persistent nonunion and infection, highlighting the complexity of some cases.

Conclusions:

• Revision ankle arthrodesis using this technique is highly effective in achieving bony consolidation and improving limb function, even in cases with significant preoperative complications.
• The described surgical approach allows for correction of malposition and addresses bone defects, leading to successful outcomes in the majority of patients.