Intraoperative and Perioperative Complications During Revision Arthroplasty for Salvage of a Failed Total Ankle Arthroplasty

• Published in: Foot & ankle international 2015-02, Vol.36 (2), p.135-142
• Main Authors: Williams, Joan R., Wegner, Nicholas J., Sangeorzan, Bruce J., Brage, Michael E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Joint - diagnostic imaging; Ankle Joint - surgery; Arthroplasty, Replacement, Ankle - methods; Humans; Intraoperative Complications; Middle Aged; Osteoarthritis - diagnostic imaging; Osteoarthritis - surgery; Radiography; Reoperation; Retrospective Studies; Salvage Therapy
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100714554452

Background: Revision of a failed total ankle arthroplasty (TAA) remains a challenge. Advances in total ankle implant design have renewed interest in revision TAA as an alternative to ankle arthrodesis or amputation in the management of a failed TAA. The purpose of our study was to review a series of failed Agility TAA revised to INBONE II TAA and identify reasons for revision as well as perioperative complications. Methods: A retrospective review of 35 cases of failed Agility TAA revised to an INBONE II TAA was performed at 1 institution. Patient demographics, indications for revision, radiographs, and complications were reviewed. The average follow-up was 9.1 months (range, 0-28 months). All revisions were performed by 1 of 2 foot and ankle surgeons familiar with both prostheses. Results: The Agility TAA lasted a mean of 6.7 years prior to revision to an INBONE II TAA. Revision TAA was indicated due to mechanical loosening, osteolysis, periprosthetic fracture, and a dislocated prosthesis. Adjunctive procedures were performed in 31 of 35 cases. There were 6 intraoperative and 5 acute postoperative complications, leading to an overall 31.4% complication rate. There was 1 patient with continued pain postoperatively who underwent a second revision of the INBONE II 20 months postoperatively. Conclusion: Revision TAA was a viable treatment option for failed TAA. A high risk of perioperative complications remains, and physicians should be aware of the challenges that occur during these procedures in order to plan for them preoperatively. Level of Evidence: Level IV, retrospective case series.