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Updated: Sep 30, 2025
Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Revision tibiotalar arthrodesis with posterior iliac autograft after failed arthroplasty: A matched comparative study
Nazim Mehdi1, François Lintz1, Mohammad Alsafi2
1Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France.
Introduction:
Tibiotalar arthrodeses performed after failed ankle arthroplasties are known to be complex procedures with often disappointing functional outcomes. This study reports the results of a revision technique using a posterior iliac crest autograft.
Hypotheses:
We hypothesized that: (1) revision tibiotalar arthrodeses (RTTAs) had functional outcomes which were similar to those of a reference cohort of primary tibiotalar arthrodeses (TTAs) and that (2) the union rate was satisfactory.
Materials And Methods:
This retrospective study compared 16 RTTAs performed for failed arthroplasties that caused pain and a functional disability (4 aseptic loosening, 4 massive progressive periprosthetic cysts, 5 malpositioning of implants, and 3 cases of unexplained mechanical pain) with a series of 16 primary TTAs performed for painful ankle osteoarthritis. The groups were matched at a 1:1 ratio for age, sex, side and body mass index. The preoperative workup included a physical exam, the American Orthopaedic Foot and Ankle Society (AOFAS) score, weight bearing radiographs, CT and SPECT scans. Outcomes were assessed both clinically (AOFAS score) and radiographically (X-rays and scans). The mean duration of the procedure (DP), average length of stay (LOS), fusion and complication rates, and time to union were also compared.
Results:
At the mean follow-up of 30 months (range, 12-88) for the RTTA group and 59 months (range, 23-94) for the TTA group (p=.001), the AOFAS score increased from 27 to 70.8 points (p<.001) and from 29.8 to 76.2 points (p<.001), respectively; values were similar at the last follow-up (p=.442). Both groups had similar fusion (94%) and complication rates (12%). The DP was 196.9±33.6min (range, 179-213) vs. 130±28.4min (range, 118-141) (p<.001) and the LOS was 3.8 days (range, 2-6) vs. 3.9 days (range, 2-6) (p<.445) for both groups (RTTA vs. TTA).
Conclusion:
This RTTA technique using a posterior iliac crest allograft for filling bone defects was validated by the quality of the functional outcomes obtained.
Level Of Evidence:
IV; Comparative retrospective study.
