Fusion after a failed primary total ankle arthroplasty

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Reconstructive surgery

Background:

• Total ankle arthroplasty (TAA) is increasingly performed, but failure necessitates salvage procedures like fusion or revision arthroplasty.
• Limited literature exists on the outcomes of ankle fusion following TAA failure.
• Understanding the survival of salvage fusions is crucial for patient management.

Purpose of the Study:

• To analyze the survival rates of ankle fusions performed as a salvage procedure after TAA failure.
• To utilize a large dataset from the National Joint Registry (NJR) for robust analysis.

Main Methods:

• A data linkage study combined NJR and NHS Digital data.
• TAA failure was defined by subsequent fusion, revision arthroplasty, or amputation.
• Life tables, Kaplan-Meier graphs, and Cox proportional hazards regression models were used to assess survival and failure rates.

Main Results:

• 131 patients underwent salvage fusion post-TAA failure, with a mean follow-up of 47.5 months.
• Overall, 22.1% of fusions failed, with 18.3% requiring revision and 3.8% resulting in amputation.
• One-year survival was 96.0%, and three-year survival was 77.5%, with most failures occurring within the first three postoperative years.

Conclusions:

• Salvage ankle fusion following TAA failure demonstrates moderate survival rates but is associated with significant reoperation and failure rates.
• Approximately 25% of patients required revision surgery within three years of the salvage fusion.
• These findings highlight the need for careful patient selection and management in revision TAA cases.