Surgical management of failed total ankle replacements in a tertiary referral centre

J. Humphrey, A. Pervez, R. Walker, A. Abbasian, S. Singh, I. Jones

Background: Management of failed total ankle replacements (TAR) remains a difficult challenge. Ankle arthrodesis, revision TAR, debridement and amputation are all utilized as surgical options. The purpose of the study was to review a series of failed TAR surgically managed in our tertiary referral centre.

Methods: A retrospective review of 18 consecutive failed TARs, either within or referred to our institution, which required surgical management were reviewed. The average age was 58.2 (range 25-77) with 11 males and 6 females.

Results: The failed implants included eight Mobility TARs, five BOX TARs, four Salto Mobile TARs and one Biomet Ankle Replacement System. Reasons for failure of implant include aseptic loosening (8/18, 44%), talus collapse (3/18, 17%), poor function (3/18, 17%), heterotopic ossification (2/18, 11%), component migration (1/18, 6%) and infection (1/18, 11%). The average duration between index procedure and second procedure was 43 months (range 6-120). Five patients further required a third surgical procedure. Definitive surgical management included tibio-talar arthrodesis (7/18, 39%), revision TARs (5/18, 28%), debridement (4/18, 22%) and a below knee amputation (1/18, 6%). All the fusions subsequently went on to unite.

Conclusions: The number of TARS being performed is increasing, so there is a need to successfully manage failed implants. Surgical options depend on the reason for implant failure, patient factors and surgical expertise. Salvage ankle arthrodesis remains favorable with high fusion rates. However revision TARs are evolving into a reliable treatment option. Further studies are required to directly compare these two modes of surgical management for failed primary TARS.