Salvage arthrodesis after failed ankle replacement: surgical decision making

Area of Science:

• Orthopedic surgery
• Reconstructive surgery

Background:

• Total ankle arthroplasty (TAA) failure necessitates revision surgery, frequently involving ankle fusion.
• Significant bone defects and challenges in achieving stable fixation complicate revision TAA salvage procedures.

Purpose of the Study:

• To guide the decision-making process for isolated tibiotalar versus tibiotalocalcaneal fusion after TAA failure.
• To present surgical techniques for managing bone defects and ensuring stable fixation in ankle fusion.

Main Methods:

• Review of indications for isolated ankle fusion versus ankle-hindfoot fusion.
• Description of surgical techniques for bone defect management (e.g., bone grafting).
• Discussion of methods for achieving stable internal fixation in complex ankle fusions.

Main Results:

• Successful ankle fusion can restore stability and function following TAA failure.
• Careful patient selection and surgical technique are crucial for optimal outcomes.
• Bone defect management and stable fixation are key to successful fusion.

Conclusions:

• Ankle fusion is a viable option for salvaging failed total ankle arthroplasty.
• Distinguishing between isolated ankle and ankle-hindfoot fusion is critical based on bone stock and stability.
• Effective management of bone defects and fixation are paramount for fusion success.