Cement Arthroplasty as a salvage for failed infected ankle replacement or ankle fusion. Is it a get out of jail card?

M. Raglan, J. Chell, S. Dhar

Aim: To assess the outcome of antibiotic impregnated cement arthropalsty for failed infected total ankle replacement or fusion.

Methods: From Jan 2012 till January 2015 there were seven patients who underwent cement arthroplasty due to intractable infection following failed ankle replacement or fusion. Of the seven patients; six patients had an infected total ankle replacement and one patient an infected failed ankle fusion. The mean age was 71 years (55-84years) with an average follow up period of 9 months (6-22 months). The primary outcome measure was duration of the cement arthroplasty. The secondary outcome measures were American Orthopaedic Foot and Ankle Scores (AOFAS), Visual analogue Score (VAS). Patients subjective assessment of the overall improvement compared to pre cement arthroplasty were recorded as well as walking aid use and pain killers consumed.

Results: The cement spacer was retained without breakage for a mean of nine months (5-22months). The mean AOFAS score improved from twenty (11-55) preoperatively to fifty-seven (50-75) postoperatively and VAS pain score from eight (5-9) to three-point-nine (1-4.5). At the latest follow-up five patients were satisfied, using small amounts of pain killers, functioning within their limits and had improved compared to preoperatively. Indeed two had resumed normal activities. One patient had died due to complications from surgery. One patient was dissatisfied and undergone a conversion to a TTC nail.

Conclusions: Primary cement arthroplasty may be an effective salvage procedure for failed infected ankle replacement or fusion. For intractable infection where patients are possibly facing a below knee amputation cement arthroplasty is an alternative procedure worth considering.