Operative Technique of Two Parallel Compression Screws and Autologous Bone Graft for Ankle Arthrodesis after Failed Total Ankle Replacement

Abstract

Background: The management of failed total ankle replacement (TAR) depends on the primary indication, presence of infection, condition of adjacent joints, and available bone stock. In addition, the patient's expectations, age, and general health should also be taken into account. Methods: This article describes a technique of arthrodesis in failed TAR with two parallel screws inserted in opposite directions and autologous cancellous bone graft. Four patients were managed using this technique. The subtalar joint and both malleoli were preserved. Results: The average time for radiological union was 14.8 weeks. There were no hardware-related complications or infections. One patient developed subsequent subtalar arthritis and is waiting for subtalar joint fusion. Conclusion: The results from this small series of patients suggest that arthrodesis following failed total ankle replacement with two parallel screws and bone graft may be an effective technique.

Level of Evidence: IV, Retrospective Case Series

Keywords

Ankle Arthrodesis Ankle Arthroplasty Aseptic Loosening Autologous Bone Graft Compression Screws Failed Total Ankle Replacement Operative Technique

Get full access to this article

View all access options for this article.

References

1. Bolton-Maggs

Sudlow

Freeman

: Total ankle arthroplasty. A long-term review of the London Hospital experience. J Bone Joint Surg Br. 67:785–790, 1895.

2. Carlsson

Montgomery

Besjakov

: Arthrodesis of the ankle secondary to replacement. Foot Ankle Int. 19:240–245, 1998.

3. Chiodo

Hahne

Wilson

Glowacki

: Histological differences in iliac and tibial bone graft. Foot Ankle Int. 31:418–422, 2010. https://dx-doi-org.web.bisu.edu.cn/10.3113/FAI.2010.0418

4. Coetzee

Deorio

: Total ankle replacement systems available in the United States. Instr Course Lect. 59:367–374, 2010.

5. Culpan

Le Strat

Piriou

Judet

: Arthrodesis after failed total ankle replacement. J Bone Joint Surg Br. 89:1178–1183, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1302/0301-620X.89B9.19108

6. Doets

Zürcher

: Salvage arthrodesis for failed total ankle arthroplasty. Acta Orthop. 81:142–147, 2010. https://dx-doi-org.web.bisu.edu.cn/10.3109/17453671003628764

7. Gougoulias

Khanna

Maffulli

: How successful are current ankle replacements?: a systematic review of the literature. Clin Orthop Relat Res. 468:199–208, 2010. https://dx-doi-org.web.bisu.edu.cn/10.1007/s11999-009-0987-3

8. Groth

Fitch

: Salvage procedures for complications of total ankle arthroplasty. Clin Orthop Relat Res. 224:244–250, 1987.

9. Guyer

Richardson

: Current concepts review: total ankle arthroplasty. Foot Ankle Int. 29:256–264, 2008. https://dx-doi-org.web.bisu.edu.cn/10.3113/FAI.2008.0256

10.

10. Henricson

Rydholm

: Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement. Acta Orthop. 81:745–747, 2010. https://dx-doi-org.web.bisu.edu.cn/10.3109/17453674.2010.533936

11.

11. Hopgood

Kumar

Wood

: Ankle arthrodesis for failed total ankle replacement. J Bone Joint Surg Br. 88:1032–1038, 2006. https://dx-doi-org.web.bisu.edu.cn/10.1302/0301-620X.88B8.17627

12.

12. Kitaoka

Patzer

: Clinical results of the Mayo total ankle arthroplasty. J Bone Joint Surg Am. 78:1658–1664, 1996.

13.

13. Kitaoka

Romness

: Arthrodesis for failed ankle arthroplasty. J Arthroplasty. 7:277–284, 1992. https://dx-doi-org.web.bisu.edu.cn/10.1016/0883-5403(92)90049-V

14.

14. Kotnis

Pasapula

Anwar

Cooke

Sharp

: The management of failed ankle replacement. Bone Joint Surg Br. 88:1039–1047, 2006. https://dx-doi-org.web.bisu.edu.cn/10.1302/0301-620X.88B8.16768

15.

15. O'Keeffe

Jr Riemer

Butterfield

: Harvesting of autogenous cancellous bone graft from the proximal tibial metaphysis. A review of 230 cases. J Orthop Trauma 5:469–474, 1991. https://dx-doi-org.web.bisu.edu.cn/10.1097/00005131-199112000-00014

16.

16. Owoola

Odunubi

Yinusa

Uregbu

: Proximal tibial metaphysis: its reliability as a donor site for grafting. West Afr J Med. 29:403–407, 2010.

17.

17. Ritter

Nickisch

DiGiovanni

: Technique tip: posterior blade plate for salvage of failed total ankle arthroplasty. Foot Ankle Int. 27:303–304, 2006.

18.

18. Smith

Wood

: Arthrodesis of the ankle in the presence of a large deformity in the coronal plane. J Bone Joint Surg Br. 89:615–619, 2007. https://dx-doi-org.web.bisu.edu.cn/10.1302/0301-620X.89B5.18109

19.

19. Spirt

Assal

Hansen

Jr : Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am. 86:1172–1178, 2004.

20.

20. Stauffer

: Salvage of painful total ankle arthroplasty. Clin Orthop Relat Res. 170:184–188, 1982.

21.

21. Thomason

Eyres

: A technique of fusion for failed total replacement of the ankle: tibio-allograft-calcaneal fusion with a locked retrograde intramedullary nail. J Bone Joint Surg Br. 90:885–888, 2008. https://dx-doi-org.web.bisu.edu.cn/10.1302/0301-620X.90B7.20221

22.

22. Wood

Prem

Sutton

: Total ankle replacement: medium-term results in 200 Scandinavian total ankle replacements. J Bone Joint Surg Br. 90:605–609, 2008. https://dx-doi-org.web.bisu.edu.cn/10.1302/0301-620X.90B5.19677