Outcomes of salvage procedures for failed total ankle replacements

N.S. Duncan, B. Chowdry, M. Raglan, S. Dhar

Introduction: We report the outcomes of salvage procedures in total ankle replacement (TAR) in a single surgeon series.

Methods: This study was a retrospective review of patients who had undergone salvage procedures with tibio-talo-calcaneal (TTC) fusion for failed TAR over a period from 1999-2013 in a single centre. In this period, 317 TAR were performed of which 11 have failed necessitating conversion to TTC fusion. Clinical documentation and radiographs were reviewed for cause of failure, type of graft for fusion, time to radiological/clinical union and complications including further surgeries.

Results: The causes of failure of the TAR were pain from instability/impingement in 8, fracture in one, subsidence of the talar component in one and infection in one. From the group of 11 patients, 8 patients went onto union at a mean of 10 months (7-14). All 8 patients had femoral head structural allografts to maintain limb length for the procedure and 3 required a secondary procedure to dynamise the nail. 2 patients with femoral head structural allografts developed infections necessitating removal of the graft and conversion to an external fixator of which one united and the other developed a painless fibrous union. 1 patient developed non-union with progressive deformity of the ankle resulting in a Symes amputation.

Conclusions: From our series of patients we have demonstrated that failure of TAR requiring salvage procedures is a relatively rare event (3.5%). The use of TTC fusion is successful in the majority of patients and the use of femoral head structural allografts allows preservation of leg length with good rates of union.