Abstract
Controversy exists regarding the most predictable salvage for failed total ankle replacement. Revision total ankle replacement with soft-tissue release/reconstruction or explantation with tibio-talo-calcaneal arthrodesis with bulk structural allograft are the most commonly performed approaches. Tibio-talo-calcaneal arthrodesis with bulk structural allograft has a high complication rate; however, augmentation with vascularized pedicled onlay bone grafts may improve osseous union and functional limb salvage. This manuscript presents the revision of a failed Agility™ LP total ankle replacement system with severe >45° varus ankle deformity that was salvaged with tibio-talocalcaneal arthrodesis, bulk femoral head structural allograft and vascularized pedicled medial malleolus and fibula onlay bone grafts. At short-term 1.5-years follow-up the patient had a well-balanced and painless foot/ankle and return of a functional lower limb.
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