Salvage Ankle Arthrodesis Research Articles

Ankle Distraction Arthroplasty combined with PRP injection for Post-traumatic Ankle Arthritis

Category:Ankle ArthritisIntroduction/Purpose:To summarize and evaluate the surgical technique and clinical outcome of ankle distraction arthroplasty with PRP injection for post-traumatic ankle arthritis.Methods:Totally 21 patients of post-traumatic ankle arthritis were treated at the department of orthopaedic surgery, Shanghai Sixth People’s Hospital. They were 13 males and 8 females with an average age of 32.5±6.2 years. The average course of disease were 14.0±2.8 months. After the failure of conservative management for at least 6 months, ankle distraction arthroplasty with PRP injection was performed in all patients. American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score system and Visual Analogue Scale (VAS) system were used to evaluate the final overall outcome. The range of motion (ROM) of ankle joint and complications were also recorded.Results:Pin tract infection was occurred in two patients, who were cured by alcohol care. 18 patients were followed for an average 36 months. The post-operative AOFAS ankle and hindfoot score was improved from 46.2±7.7 to 79.2±11.6 (t=-14.58, P ＜0.05), while the VAS score was decreased from 6.6±1.1 to 1.8±2.0 (t=16.424, P＜0.0001). The dorsal extension of ankle joint was increased from 1.3±9.3° to 8.1±5.5° (t=-4.675, P＜0.0001) and the plantar flexion was improved from 14.4±6.8° to 26.9±7.3°(t=-7.919, P＜0.05). The radiograph manifested the progressive course of ankle arthritis in four patients, two of which were cured by a salvage ankle arthrodesis by consequence of a failure of conservative treatment for persistent pain and functional limitation.Conclusion:The ankle distraction arthroplasty is an effective ankle preserving surgery, which could relieve symptoms, improve functions and delay the course of post-traumatic ankle arthritis

Anterior Plating With Retention of Nail for Ankle Nonunion After Tibiotalocalcaneal Arthrodesis

Tibiotalocalcaneal arthrodesis (TTCA) by retrograde intramedullary nailing (RIMN) may result in isolated nonunion of the ankle joint. In these cases, revision TTCA with RIMN may be technically difficult and carry some morbidity. However, if the subtalar joint has achieved union a full revision of RIMN may be unnecessary. This report describes a technique of anterior plating with retention of nail as a salvage option for patients with this problem. In addition, outcomes are reported for 6 patients who underwent anterior plating with retention of nail for isolated ankle nonunion after attempted TTCA by RIMN. All 6 patients achieved tibiotalar fusion at an average of 9.3 weeks (range, 5.4 to 16.1 wk) postoperatively and average pain scores significantly improved (7.8 to 5.3, P=0.019) postoperatively. One major complication and 1 minor complication occurred. Anterior plating with retention of nail appears to be a viable option for salvage ankle arthrodesis after failed TTCA by RIMN; however, detailed preoperative counseling regarding the potential risks of surgery should be performed. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Anterior Plating with Retention of Nail for Salvage Ankle Arthrodesis After Failed Tibiotalocalcaneal Fusion

Category: Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal arthrodesis (TTCA) by retrograde intramedullary nailing (RIMN) is commonly used to treat degenerative disease affecting both the tibiotalar and subtalar joints. In the event of TTCA failure, techniques for salvage arthrodesis are not well-described. The aim of this study is to demonstrate the feasibility of anterior plating with retention of nail as a salvage option for patients who experienced failed TTCA by RIMN. Methods: Six patients with failed TTCA following RIMN underwent revision ankle arthrodesis with anterior plating and retention of nail between July 2013 and July 2015. Patient demographics, presentation details, and clinical records were reviewed for clinical and patient-reported outcome measures. Postoperative outcomes consisted of visual analog scale (VAS) pain rating, Coughlin satisfaction scale, Foot & Ankle Activity Measure (FAAM) score, and complications. Results: Anterior plating was performed at a mean of 15.8 months (range, 6.3-25.7) after primary TTCA by RIMN. All patients achieved bony fusion at an average of 9.3 weeks (range, 5.4-16.1) postoperatively. Postoperative outcomes at 1 year follow-up demonstrated an average VAS score improvement from 7.8 to 5.3 (p = 0.019) and an average postoperative FAAM score of 50.9 (range, 37.5-75.0). One major complication occurred in a patient who had a posterior tibial nerve neuroma from the initial TTCA procedure. Despite achieving union following anterior plating, the patient had several subsequent procedures to manage the neuroma but eventually required amputation. There was one minor complication consisting of postoperative swelling requiring a compressive stocking. Conclusion: Anterior plating with retention of nail is a viable option for salvage arthrodesis in patients with failed TTCA after RIMN. Given the complex presentation of most patients with this problem, detailed preoperative counseling regarding the potential risks of surgery should be performed.

Ankle arthrodesis after failed total ankle replacement: a systematic review of the literature.

As the number of total ankle replacements (TARs) performed has risen, so has the need for revision. The purpose of this investigation was to perform a systematic review of clinical outcomes following a salvage ankle arthrodesis from a failed TAR to identify patient- and technique-specific prognostic factors and to determine the clinical outcomes and complications following an ankle arthrodesis for a failed TAR. We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for studies that analyzed ankle fusion after failed TAR with a minimum follow-up of 1 year. We included 16 studies (193 patients). The majority of patients (41%) underwent the index TAR for rheumatoid arthritis. The majority of these revision surgeries were secondary to component loosening, frequently of the talar component (38%). In the cases that were revised to an ankle arthrodesis, 81% fused after their first arthrodesis procedure. The intercalary bone graft group and the blade plate group had the highest rate of fusion after the first attempt at fusion at 100%, whereas the tibiotalocalcaneal fusion with cage group had the lowest fusion rate at 50%. The overall complication rate was 18.2%, whereas the overall nonunion rate was 10.6%. A salvage ankle arthrodesis for a failed TAR results in favorable clinical end points and overall satisfaction at short-term follow-up if the patients achieve fusion. The bone graft fusion and blade plate group resulted in the highest first-attempt fusion rate, with a low complication rate. Future studies should include prospective, comparative control or surgical groups and use standardized outcome measurements that will make direct comparisons easier. Level IV: Systematic Review of Level IV Studies.

Sprunggelenkarthrodese nach gescheiterter Endoprothesenimplantation

Despite recent anatomical and biomechanical improvements the longevity of current total ankle replacements remains limited. Once total ankle replacement has failed conversion into ankle arthrodesis provides a viable option and should therefore be considered. However, due to the massive bone loss, precarious soft tissues and in order to preserve leg length, this kind of surgical treatment is considered to be technically demanding with potential impairment of the quality of life and decreased global foot and ankle function as well. The present article focuses on salvage ankle arthrodesis after failed total ankle replacement and seeks to provide a usable treatment algorithm.

Salvage arthrodesis for failed total ankle arthroplasty

Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease.Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction.Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles.Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good.

The use of circular wire external fixation in the treatment of salvage ankle arthrodesis

The authors retrospectively reviewed their experience with circular wire external fixation in the treatment of salvage ankle arthrodesis during the past 9 years. The results of 43 cases in a difficult patient population are presented with an average follow-up of 27.0 months. Thirty-three patients (80.5%) went on to achieve a solid fusion or stable pseudarthrosis. A minimum of a 4-ring frame construct was applied for an average of 96.1 days. The major complication rate was 51.2%, including 3 below-knee amputations (7.3%), 7 unstable nonunions (17.1%), 7 cases of osteomyelitis and/or deep-space infection (16.3%), 3 malunions (7.3%), and 2 tibial stress fractures (4.7%). The incidence of complications occurred similarly in patients with Charcot arthropathy, failed total ankle arthroplasty, septic fusion, posttraumatic deformity, or avascular necrosis of the talus, whereas it was relatively higher in patients who were diabetics, smokers, or had an increased body mass index. In addition, the incidence of a nonunion tended to increase with longer follow-up, suggesting that early presumption of a solid union may be erroneous. Based on our defined criteria of a stable, well-aligned fusion without severe pain or activity restrictions, 28 patients (68.3%) had a good result. Circular wire external fixation can be a viable treatment for complex ankle salvage pathology; however, it is difficult to predict the prospects of success or failure.