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Revision of Total Ankle Replacements

2011; Lippincott Williams & Wilkins; Volume: 10; Issue: 4 Linguagem: Inglês

10.1097/btf.0b013e3182376f11

1538-1943

Jean‐Luc Besse, Bernhard Devos Bevernage, Thibaut Leemrijse,

Lower Extremity Biomechanics and Pathologies

We discuss the medium-term and long-term complications of total ankle replacements (TARs) requiring revision surgery. TAR failures include the following reasons: stiffness, periprosthetic ossification and malleolar impingement, medial or lateral hindfoot instability, loosening and/or subsidence of the components, and infections. Before performing any revision surgery, the etiology of the failure must be established. The analysis must not focus solely on the ankle but should also consider the overall biomechanics of the lower limb and the interrelationship between the knee joints, the subtalar joint, and the midfoot. All the factors responsible (malalignment, instability, stiffness, and problems with joints above or below the ankle) should be analyzed. Non–prosthetic-related and periprosthetic pathologies can be addressed by additional osseous or soft tissue procedures without revision of metallic prosthesis components. Bony cysts, whose frequency is underestimated in most reported series, without affecting the stability of the implant, may require an autograft or additional bone substitutes. There is only limited literature addressing the long-term viability of graft, and therefore, no valid evidence-based recommendation can be made. The causes of dislocation of the mobile component, an inherent complication of 3-component prostheses, must be investigated. In addition to any ligament (supplementary arthrolysis, iterative ligamentoplasty) and/or bone procedures, the polyethylene inlay must be replaced systematically. For late-onset chronic infections, revision in 1-stage or 2-stage procedures requires the initial removal of the implant followed by an extensive debridement of all the infected tissues. A revision in the 2-stage procedure can include the use of a spacer and/or an external fixator, especially if skin problems are present. If there is a non–prosthetic-related reason for the failure, the prosthesis will only be replaced after correcting the non–prosthetic-related conditions that caused the prosthesis to fail. Any replacement is also dependent on the remaining bone capital after the removal of the prosthesis. The greater the amount of bone loss, the more uncertain the replacement of the prosthesis and, if necessary, an arthrodesis will then be discussed. The revision rates of ankle replacements without replacing the prosthesis remain high in the literature. TAR is one of the surgical procedures that can be considered in treating degenerative ankle disorders.